Medicaid buy-in: Band-Aid and stall

Medicaid buy-in: A Band-Aid for the Affordable Care Act (ACA)
that could stall universal health care for years

by Ivan J. Miller, Ph.D., Executive Director

(Read Dr. Miller’s Op Ed on the Medicare-X plan here.)

Some candidates tout a Medicaid buy-in plan as a Colorado-based step toward universal health care.

Claiming that true universal health care must wait for a national Medicare for All plan, these politicians sell the Medicaid buy-in as a here-and-now Colorado solution.

Waiting for a federal solution is the most unlikely pathway toward universal health care.

Beginning in 1962, Canada passed universal health care one province at a time. The most likely pathway in the U.S. is also one state at a time. Colorado is not alone in this pursuit; 22 states have attempted universal health care legislation, and some are close to success[1].

A Medicaid buy-in sounds good, but examined closely it:

  • Diverts Colorado’s energy away from a state universal health care plan.
  • Would only affect the 8 percent of Coloradans who buy insurance on the Exchange.
  • Is still too expensive. Because Medicaid has no deductibles or significant copays, the cost to buy-in on the Exchange would likely be more than for high-deductible plans.
  • Could hurt providers. Because Medicaid only pays 65 percent of the cost of providing service[2], providers take Medicaid as part of charity care. Expecting providers to offer more charity care is no way to fix the health care system. Also, there’s no guarantee providers will accept new “public option” Medicaid patients.
  • Won’t work. Proponents claim that competition from the Medicaid buy-in will start to bring health care costs down. The U.S. has been using competition for over 50 years: U.S. health care costs are twice as high as in most industrialized countries and continue to skyrocket. Competition does not adequately contain health care costs in the U.S. and never has anywhere else in the world.
  • Is not universal health care or Medicaid for All. At best, it’s a self-supporting public option on the Exchange for those who can afford it.
  • Cannot be done right away; it would require at least five years. Necessary federal waivers need to wait for a new President in 2020, and then it would take till 2022 to implement and till 2023 to evaluate.

The Medicaid buy-in would make the health care system even more complicated and almost as expensive; it would only slightly lower the number of uninsured (350,000) and underinsured (850,000) in Colorado[3].

Let’s call Medicaid buy-in what it is — a Band Aid on the ACA that would postpone any true solution for five years or more.

It would be better to invest now in the developing the real deal: A Colorado universal health care plan.

The governor and legislature should work for what the people want — a universal health care plan that simplifies and lowers the cost of health care, and that finally brings the number of uninsured and underinsured in Colorado to what each should be: Zero.

  1. Public Citizen
  2. 208 commission report Colorado Blue Ribbon Commission on Health Care Reform, (January 31, 2008). Figure: Summary comparison of hospital payment levels in Colorado, Final report to the Colorado General Assembly. Colorado State Government, Denver, CO
  3. Colorado Health Institute Health Access Survey
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