No Apology by Mitt Romney

Author:Mitt Romney
Language: eng
Format: epub
ISBN: 9780312609801
Publisher: St. Martin’s Press

On to Medicaid. When I was governor of Massachusetts, the Bush administration’s then secretary of health and human services Tommy Thompson proposed a straightforward and uncomplicated plan to fix the Medicaid program. Appearing at the annual governors’ conference, he proposed that each state annually be given the Medicaid dollars it had received during the prior year, adjusted for inflation and changes in the state’s population of the poor. The state would be allowed to fashion its health-care program for the poor as the state chose.

You might imagine that the fifty Republican and Democratic governors would have recoiled at the idea; after all, overall inflation rises far more slowly than does health-care inflation. In fact, however, the proposal was welcomed by many in both parties. A number of us had already filed requests at the Department of Health and Human Services for waivers that would allow us to adjust our states’ Medicaid program because, over the years, we had watched as its intent to care for the poor had been distorted by some very creative people.

Have you seen advertisements by lawyers claiming that with their help, the government will pay for nursing-home costs regardless of one’s assets? They have found ways to turn wealthy retirees into poor people—at least for the purposes of qualifying for Medicaid nursing-home care. Now millionaires can give their fortunes to their children, become “poor,” and qualify for Medicaid. And as a result, middle-income retirees see no need to purchase long-term care insurance. An operator of a chain of nursing homes said that twenty-five years ago, Medicaid paid the bills for about 20 percent of the people in their nursing homes, while 80 percent were covered by their own private insurance. Today those numbers have been reversed. If the government is willing to give away money, there will always be a long line to get it.

These distortions and inequities in Medicaid have become so severe that governors like me were willing to trade the federal government’s open checkbook for the ability to control our own state’s program. We were convinced that we could save money and provide better care for more people who really needed it. Yet Congress rejected Thompson’s plan. Since then, I haven’t seen a better idea for fixing Medicaid come so close to becoming law.

There are other cost-saving options for Medicaid as well. Recipients could be moved to managed care plans. A 2004 report from the Lewin Group found savings in the range of 6 to 12 percent could be achieved via this route. Or states could pay a standard fee for each covered individual to a primary care practice or community health center. This would provide cost certainty and better care for the poor.

Rather than allowing Medicaid members to go to any hospital, states could negotiate with fewer providers to obtain better rates. Or we might let Medicaid recipients opt out of the Medicaid program, give them an equivalent voucher, and allow them to purchase private insurance instead. The best way to see

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