For good reason, health care advocates are worried about a state proposal to exempt itself from a wide range of Medicaid rules.
The state plan has the potential to open the way to putting more of the state’s population off health insurance all together. In many cases, those would be people who work hard but for poor wages, especially in the service sector.
The proposal for a waiver of Medicaid rules will go to the federal government at the end of this month. Federal officials ought to look at the request with a great deal of skepticism, especially if it is presented as currently written. There is no reason for the federal government to throw out protections for Medicaid recipients that were created by Congress exactly because of concerns that states might make arbitrary decisions.
Before then, however, Dennis Braddock, secretary of the state Department of Social and Health Services, should scale back this overly broad request. It’s too big and undefined. The state could simply put people on waiting lists if it ran short of funds for programs or groups that the federal government considers optional for Medicaid coverage rather than mandatory.
Even so, it must be said that Braddock’s plan has merits. And it has been presented in good faith, with an admirable aim of giving the state enough flexibility to protect aid recipients’ health even in times of budget constraints. Those goals are important enough to justify continuing with a limited request for exemptions. A narrower request, however, would help ensure that big changes aren’t made without adequate discussion.
Congressional concerns about Medicaid have historically has been focused on state legislatures. As the DSHS points out, Washington does have a strong record in providing health care to poorer people, which should suggest a certain amount of trust. Like all legislatures, however, Washington makes many of its budget decisions behind closed doors in the final hours of a session, when everyone’s attention is focused on escaping Olympia not calmly debating health care for the working poor. Then there’s the dispiriting dysfunctionality of recent state legislatures and much of the state’s political process. The budget pressures on health care have been compounded by the increasing prevalence of fiscal initiatives — some limiting taxes, others increasing expenditures for p.r.-pretty purposes. There’s no reason for the feds to let legislators fix such atrociously bad decision making at the expense of Medicaid protections. In this situation, Washington could also be one of the states most tempted to abuse such discretion.
With the state budget in bad shape, there will be pressures to cut state health costs. Advocates suggest efforts to ease the costs of prescription drugs by enacting a state list of preferred drugs for Medicaid programs (something sure to be challenged by pharmaceutical companies). The state might look even further at the health care costs for state employees.
A limitied waiver could be part of a broad package of efforts to limit the costs of health care. A broader one, however, could be an invitation to trouble, especially in this economy.
This is one of a series of occasional editorials on access to health care. Earlier editorials can be found by searching our HeraldNet Web site.
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