Doctors know that the key to a cure is the right prescription, administered at the right time. When it comes to the Texas health care system, expanding Medicaid is the wrong prescription — and it couldn’t come at a worse time.
What’s a more effective approach? Improving Medicaid, so that it better serves those it’s meant to help, and expanding options for uninsured Texans without overloading our Medicaid system.
First, the malady. Medicaid is an important program that was instituted to provide health coverage for those most at risk: the elderly, the disabled, eligible women and children. But the more we ask of Medicaid, the less it’s able to perform its original mission.
Coverage isn’t care. Fewer than half of all Texas doctors are enrolled in the Medicaid program and even fewer are taking new patients — which is why the state pays more than $1 billion on emergency room claims alone. When Medicaid enrollees can’t get an appointment when they’re sick, they go to the ER.
Even worse, 166,416 people with disabilities, mostly children, are on an interest list awaiting an opportunity to benefit from the Medicaid program.
What would it mean to add an additional million Texans to the Medicaid rolls while not adding a single physician or other provider? It would mean even longer wait times, more crowded ERs, less access to care and worse health outcomes for the people who need Medicaid the most.
The difficulty in getting care — despite having coverage — is precisely why nearly 600,000 people who are eligible for Medicaid have chosen not to enroll in the program. These people are considered uninsured although they have options available to them.
But there’s hope. We can improve Medicaid and explore other options for the uninsured.
One improvement would be to allow Medicaid dollars to fund Direct Primary Care arrangements for Medicaid recipients. In DPC, patients pay physicians a subscription fee (often less than $80 per month) that covers most of the primary care and urgent care we all need.
Using innovative technology such as HIPAA-compliant smartphone apps, patients can build the kind of effective relationships with their doctors they could never have in an ER setting. Many DPC physicians report they’re able to treat long-term issues such as diabetes more effectively with that strengthened doctor/patient relationship.
We can also use programs such as Federally Qualified Health Centers to address the health care needs of at-risk and lower-income patients.
When combined with guaranteed-coverage pools for those with high-cost health needs, we can make real improvements in the health and well-being of Texans — without blowing up the Medicaid system that many Texans rely on.
Proponents of expanding Medicaid say Texas is leaving “free” federal money on the table by not doing so. But taxes are taxes, whether we’re sending the money to Austin or to Washington.
What’s important is ensuring our taxes are being efficiently and effectively used to achieve the goal: providing health care (not merely coverage) to those who need it most.