New York Times: Medicaid Rationing “A Sign of the Times”
This weekend, the New York Times reported on reaction to the Arizona Medicaid program’s recent decision to end coverage of heart, liver, lung, pancreas, and bone marrow transplants, “treatments urgently needed to ward off death.” Diane Rowland, head of the liberal Kaiser Commission on Medicaid and the Uninsured, said the decision “is a classic example of making decisions based not on medical need but a budget.”
Arizona’s governor is Republican, as is a majority of its legislature, but the article notes that “the options available to states for cutting Medicaid have been limited because the federal stimulus package and the health care law have required them to maintain eligibility levels. That has left states to cut payments to providers and trim benefits not required by federal regulations.” In other words, because Democrats in Washington didn’t give states fiscal flexibility to manage their Medicaid programs, Republicans in Arizona have been forced to make difficult coverage decisions.
Unfortunately, the head of the National Academy for State Health Policy said Arizona’s action to deny coverage of organ transplants was a “sign of the times” and “a precursor to a much larger number of states having this discussion.” States are already facing massive amounts of debt and high structural deficits; a separate New York Times article on Sunday talked about state budgets being “overwhelm[ed]” in a sea of red ink. Yet these same states will soon be forced to assume responsibility for covering 18 million new Medicaid enrollees – to say nothing of the cost of establishing their own insurance exchanges, and complying with the health care law’s myriad new regulations and mandates. With the new law set to raise health care costs, and states facing tremendous fiscal pressures, many will have no choice but to ration access to costly but life-saving treatments.
This unfortunate scenario might have been what Centers for Medicare and Medicaid Services Administrator meant when he said last year that “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.” Medicaid patients in Arizona – and potentially in other states as well – may soon discover the import of Dr. Berwick’s remarks.