There is a great debate in Michigan and in other states around the nation on the topic of Medicaid Expansion. Like most of you reading this, I desire to find ways of providing access to quality, affordable healthcare for more Americans. But I wonder, is expanding Medicaid the best way to do this? What if you could provide access to affordable quality care to more individuals without expanding Medicaid? After extensive research, I have come to see that there are other, more sound options.
Rising healthcare costs are a serious issue for all of us. And costs are increasing in most areas of healthcare, but not all. Where are costs not increasing and what can we learn from this? Look no further than free market healthcare segments such as laser eye surgery or plastic surgery.
Medicaid, on the other hand, joins the long list of government services that do not promote quality. Due to the poor Medicaid reimbursement rates for services many physicians try to control costs by capping the number of Medicaid patients that they serve. As more and more doctors begin refusing Medicaid recipients to avoid going out of business, where will these people go to be treated?
The Affordable Care Act (aka Obamacare) seeks to control costs by increasing the premiums for everyone and then providing subsidies, tax breaks or outright waivers to special segments of our society. For example, employers with 25 or less employees will receive up to 40% subsidies on their healthcare costs. I suppose this is to hold them harmless in light of the projected premium cost increases of 30-60% in our state. This is not “cost control”. It is simply “control”.
When you boil down the options available to us when it comes to healthcare systems, there are three basic choices: federal control, state control, or individual control. The Governor’s proposal to implement Obamacare by expanding Medicaid and utilizing a state-operated exchange is an example of federal control. An excellent example of a state controlled option is Senator Bruce Caswell’s bill SB 422. His option would likely not require any waivers from existing federal law nor would it rely upon additional federal funds. As a third option, I have been pursuing a Michigan healthcare system that prioritizes individual control and the free market.
This third option starts with the observation that the proposal pursued by the Governor called for two waivers by the federal government. If waivers are on the table for discussion, I would like to propose two alternative waivers that get to the heart of why I believe that the Affordable Care Act is neither “affordable” nor “caring”.
The first of these waivers is to Obamacare’s “minimum essential benefit” mandate. It is this mandate that is the primary driver behind the obscene jumps in healthcare premiums our citizens will see in October of this year as open enrollment begins on the government-run health exchange. Many people would simply like catastrophic insurance rather than all of the bells and whistles found in the minimum essential benefit laundry list. They should have that choice.
The second of these waivers would be to allow government assistance eligibility information to be provided via one or more private exchanges rather than a single government-created exchange. Limit the government involvement to its current role of determining eligibility for government assistance. Let the private sector provide a framework where competition thrives in a consumer-friendly environment and people have more choice over what type of insurance they think is right for themselves and their families.
These two waivers would put Michigan on a path to lower healthcare costs and expanded access to healthcare that would not only improve the health and well-being of our citizens, but would also improve our competitiveness with other states for jobs. Do you remember when competition, personal responsibility and freedom were core American values? It is time to restore these principles in our government policies.
This July 4th, we celebrate our independence and we celebrate our freedom. I implore you to not take that freedom for granted. If you do, there are too many people in government more than willing to exchange some of your freedom for a false sense of security. Obamacare is about control not freedom. If we truly want to increase access to quality care for all of our citizens, we need to pursue free market solutions.