September 15, 2008

The Times and the Medicaid Waiver

Carroll Andrew Morse

The New York Times editorial board says the Carcieri administration's plan to redesign Rhode Island's Medicaid program is risky…

Under the proposed waiver, the federal government would contribute a fixed annual amount for the next five years (roughly what it was projected to spend anyway), but Rhode Island would limit its contribution to 23 percent of its general revenue budget….

The state is hoping to make up the difference, without harming patients, by providing health care more cheaply. It wants to require most long-term care patients to get treatment at home or from community-based services rather than in expensive nursing homes and would put virtually all beneficiaries in managed care.

If that isn’t enough, it wants flexibility to charge higher co-payments, put people on waiting lists for treatment, and limit the duration and scope of services.

My question is, perhaps with the exception of the higher co-payments, how are the actions cited in the Times editorial substantively different from standard liberal Democratic plans for implementing universal healthcare?

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Didn't close an italic tag again.

Posted by: Greg at September 15, 2008 12:35 PM

The Medicaid waiver will provide RI the freedom to develop a program that is responsive to our population.

In the early 90’s, Wisconsin Governor Tommy Thompson requested a global waiver for welfare that would give him the freedom to develop a program adequately responsive to his population. It was so successful that Newt Gingrich proposed changing all states over to this block grant/waiver type of system and President Clinton signed the legislation in 1996. This allowed each state to develop its own welfare system.

Most states created “work-first” models and the nation saw the largest decrease in poverty and dependency ever recorded. Some states did not produce effective program (like RI) and it took longer for the people to gain control. But they eventually did reform the programs.

It works because it brings local control and scrutiny over the implementation of the program rather than it being run by bureaucrats in DC. The global Medicaid waiver will provide the same freedoms for the implementation of healthcare here in RI. The waiver does not prescribe how services are administered but simply provides the freedom to work without federal regulations and mandates. Now the question becomes, we will have the will to implement free-market reforms.

Posted by: William Felkner at September 15, 2008 3:24 PM

I'd say that in general, "liberal Democratic" plans for universal health care don't promise to "put people on waiting lists for treatment, and limit the duration and scope of services."

(I should also say that our current, non-universal health care system certainly involves waiting lists and limits on the duration and scope of services.

Posted by: mrh at September 16, 2008 9:12 PM

You're right they don't "promise" to "put people on waiting lists for treatment, and limit the duration and scope of services." But of course they will!

Posted by: bobc at September 17, 2008 1:12 PM
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