Senator Tom Coburn has some help in this column from last week about what his home state is doing to try to rein in runaway Medicaid costs:
They’d Sooner Fix Medicaid — Can market incentives save the system?
BY TOM COBURN AND REGINA HERZLINGER
Thursday, May 18, 2006 12:01 a.m. EDT
OKLAHOMA CITY–The state Legislature here is working to finalize an agreement for Medicaid reform legislation creating personal health accounts (PHAs) for Medicaid enrollees. This comes hard on the heels of similar innovations in South Carolina and Florida. Reform is in the air–much the way it was when Wisconsin revolutionized its welfare system in the early 1990s, forerunning a stunning national success. Are we on the verge of consumer revolution in health care?
It is of course too soon to tell, but the Oklahoma case study is auspicious. The state’s antiquated Medicaid bureaucracy has fostered, by turns, a lack of patient choice, provider dissatisfaction, a 9.5% payment error rate, and an escalating price tag of some $3.5 billion. Against these discouraging trends, state leaders spent six months last year formulating stopgap measures with state agencies, policy innovators, providers and beneficiaries.
Instead of assuming the indigent are incapable of decision-making, Oklahoma legislators proposed that Medicaid beneficiaries be given a risk-adjusted allowance to purchase private health insurance. A PHA would be established for annual out-of-pocket expenses without a “use it or lose it” penalty–that is, the unspent balance could be used for future health-care needs.
Having said that, I do hear a bit of an echo in Mr. Coburn’s piece in what I wrote back in October:
New York, Ohio, and other high-cost Medicaid states would actually be better off if they entirely funded health-care allowances for all Medicaid recipients and told them “Here. This is yours to spend ONLY on medical care. If you go over the allowance, we’ll cover you. But we’ll split the savings with you every year that you stay under.†Access to the money would only be permitted by approved medical providers, and the accounts could be easily monitored by state and federal auditors. Overall, I would characterize it as the voucher concept with a cost-saving twist.
Oklahoma’s system sounds better, with enrollees “keeping” all the leftovers, but having them earmarked for future healthcare. (I do wonder what happens to the leftovers when someone comes off of Medicaid.)
Later in the piece, Coburn and Regina Herzlinger mention Ohio as a state that has enacted Medicaid choice. We’ll have to see whether this reins in the state’s previously out-of-control growth in Medicaid cost.