In Push to Reshape Medicaid, States Must Put Patients First

In Push to Reshape Medicaid, States Must Put Patients First
AP Photo/Jose Luis Magana

With all the buzz over Republicans’ failed efforts to repeal Obamacare, many Americans may assume that all the action to overhaul health care is happening in Congress. Nothing could be further from the truth. Less noticed, but also critically important, is the fact that governors across the nation, including here in Massachusetts, have been invited by Trump administration health officials to reshape their states’ Medicaid programs through a process of requesting special federal waivers.  

The power Gov. Baker holds to reshape MassHealth is significant considering the 1.9 million Bay Staters — 30 percent of Massachusetts residents — who have access to health care through Medicaid. Patients should be the first and most important stakeholder in any health-care policy decision, whether that decision is made by a legislator, health-insurance commissioner, insurance company CEO, president, or — as in this case — a state governor.

Just last month, Gov. Baker submitted his Medicaid waiver request to the federal government. This waiver request seeks to consolidate and reshape coverage for non-disabled adults in Massachusetts, moving approximately 140,000 low-income enrollees to subsidized commercial plans. These changes will impact Massachusetts Medicaid recipients dramatically. 

By placing these individuals into the Health Connector, out-of-pocket costs will increase. Today, Medicaid out-of-pocket costs (including premiums) are limited to 5 percent of total income. When beneficiaries are moved off of MassHealth, they will be subject to out of pocket costs up to $1,250 annually for an individual and $2,500 for a family. That is more than twice the amount a recipient currently has to pay. Beneficiaries could also be required to pay for dental care, a benefit that is currently accessible to enrollees. 

Gov. Baker’s plan to move another 230,000 poor non-disabled adults into a common Alternative Benefit Plan reduces access to long-term care services as well as coverage for non-emergency medical transportation. These adults have incomes below the poverty line and scant resources, so without these transportation services, they may very well see reduced access to services and providers. 

Gov. Baker is also attempting to cut access to life-saving medicines for the entire MassHealth program. Restricting available medications and denying access to the latest drugs approved to treat cancer and HIV is shortsighted and bad public policy for our most vulnerable residents.

All told, such changes could effectively ration people’s health care by providing it to only those who can afford it.

Before Gov. Baker takes the Trump administration up on its offer to “align Medicaid and Private Insurance Policies for Non-Disabled Adults,” we urge the people of Massachusetts to make their voices heard. Aligning state Medicaid policies with those of private insurance carriers may be a worthy policy goal, but it demands careful consideration. Patients and policymakers alike can agree that Medicaid can look to private insurance for ways to make the system more efficient and to promote well-coordinated care. We at Consumers for Quality Care applaud those efforts, while also cautioning that some efficiencies come at the expense of patients.

Americans count on our governors to protect their states’ most vulnerable and uphold standards for quality, affordable health care. As a result, Gov. Baker must keep Medicaid beneficiaries top of mind as he finalizes waivers requests from federal Medicaid standards. We also strongly encourage him to adopt the following principles for assessing the scope and breadth of any potential waiver request: 

  1. High-quality, comprehensive health care should be available and affordable to all Americans.
  2. Insurance design should be improved to better meet the needs of consumers.
  3. The health-care delivery system should be modernized to put the patient at the center.

With these as standards for advancing waiver requests, Medicaid beneficiaries in Massachusetts can get the better-quality care they deserve. We hope the people of the commonwealth will also seize the moment and speak up for the kind of health-care coverage they need. Help us make sure patients stay covered by making your voice heard. 

Jim Manley is a former senior adviser to Sens. Edward Kennedy (D-Mass.) and Harry Reid (D-Nev.). Former Del. Donna Christensen (D) represented the U.S. Virgin Islands in the House of Representatives from 1997 to 2015. Scott Mulhauser is a visiting fellow at the University of Pennsylvania and former senior adviser to the Senate Finance Committee and Vice President Joe Biden. Jason Resendez is executive director of the LatinosAgainstAlzheimer’s Network and Coalition. They all serve on the board of directors of Consumers for Quality Care.

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