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Understanding Medicaid, Trump’s Push for Accountability, AMAC’s Role

medicaid

Medicaid is complicated, expensive for taxpayers, and under growing pressure.  President Obama expanded it wildly, which triggered a rush to the federal match troth by governors; President Trump has tried to reign it in, but with limited success.  Let’s simplify, even if we cannot make it any cheaper in this column.  Change is clearly afoot.  

First, Medicaid offers healthcare benefits to the poor, a worthy cause and one that wins a federal match for State commitments.  President Obama’s “Affordable Care Act” expanded coverage, redefining poor as “138 percent” of the “poverty line,” effectively mandating an all-or-nothing approach by governors.  Go high, or go it alone. 

As a result, more than 30 states expanded Medicaid, effectively offering eligibility to anyone making under $16,750 dollars.  That increased coverage raised costs to the State and Federal tax base.  That would be you and me.  

The change did not sit well with all governors, many of whom felt caught.  In 2012, the US Supreme Court gave States the chance to “opt-out.”  States that stayed got the full federal match; those who left did not lose existing federal funds but were not otherwise obligated.   

Some States still wanted a third way, avoiding heavier taxes resulting from the expanded poverty definition – which many also thought reduced the incentive to work, yet allowing Medicaid coverage for those at 100 percent of the poverty line, just not up to 138 percent.

This request, resisted last year by the Trump Administration, is now being reconsidered – as President Trump’s Health and Human Services Secretary and several Republican Governors favor the shift.  In effect, this shift would put more power in State hands, permitting federal matches below the 138 percent level, but would not end federal matches – or the larger Obama-era program.

All this said, while Americans always wish to help the poor, Medicaid expansion continues to create operational, definitional, bureaucratic and political problems for responsible governors and taxpayers. 

That is one reason that AMAC members – and AMAC’s President Dan Weber –  support initiatives like the “Physician Pro Bono Care Act,” H.R. 856, introduced this session by Representatives Dan Webster (R-FL) and Colin Peterson (D-MN), with five hard-won co-sponsors and strong AMAC reinforcement. 

This AMAC-supported bill allows those eligible for Medicaid and the CHIP program (Children’s Health Insurance Program) to get quality care, keeping their doctor, preserving long term relationships, while giving physicians the commensurate charitable tax deduction, avoiding the administrative costs, burdens and time-wasting entanglements.  The annual net savings from this charitable deduction approach to Medicaid and CHIP is multiples of the deductions.  As Dan Weber laconically noted, it is a “win-win.”

That said, the wider Medicaid Program is in trouble.  On top of debate about how to empower states, reduce costs and more accurately target those in need, another monster looms – bogus overpayments.  That was the topic of congressional oversight in the Republican-controlled Senate this month. 

In essence, Republican Senators Chuck Grassley (R-IA) and Pat Toomey (R-PA) noted this month that Medicaid has not seriously sought to recover overpayments for more than 25 years.  Ineligible award reports continue to spike, according to oversight experts.  This raises tax and spending burdens for States, the Federal Government – and you and me, the taxpayers. 

So, in a nutshell, Medicaid is being seriously re-looked, at Federal and State levels, based on swelling rolls, State concerns about eligibility, cost and accountability.  In the end, renewed attention on Medicaid – and innovations like the “Physician Pro Bono Care Act” – are a good thing. 

But let us all be serious – none of this renewed focus on Medicaid options, alternatives, costs and accountability would have happened under the prior administration.  The Trump White House has turned a page, pushing balance between access and accountability – and AMAC has been pushing right beside them, seeking to rein in costs and waste, while protecting those who need it. 

Unfortunately, Medicaid is still complicated, expensive, and under pressure.  But now, you know a little more about its promise and predicament, perils and possibilities.  As the Trump Administration’s focus on promoting federal accountability and transparency grows, stay tuned! 

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Read more articles by Robert B. Charles

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Maria

I wonder if a tax credit instead of a tax deduction, would be a better way to go about creating an incentive for doctors to participate in the “pro Bono act”?

Dan W.

If AMAC wanted increased support of the “Physician Pro Bono Care Act” from the medical community, AMAC should propose a change to the current draft of the “Act” to offer participating physicians a tax credit rather than a tax deduction for their services.