The Texas Legislature is facing a huge budget deficit and must either cut expenses or raise taxes. This is Texas, so we know our taxes won’t be increased. That means severe cuts in services, and the only question is which services, and therefore which residents, suffer the most.
The Houston Chronicle ran an article about proposed cuts to the Texas Medicaid system, and the effect those cuts might have. Here are excerpts from the article:
If we played drinking games during editorial-board meetings, the phrase “penny-wise and pound-foolish” would be the death of our livers. In these dark days, in our endless discussions of the terrifying state budget proposed for Texas, it is the Cliché That Cannot Be Avoided.
It comes up in meeting after meeting, e-mail after e-mail, from group after group, from outfits representing senior citizens, the middle class, children, the court system, hospitals, doctors, universities, the mentally ill and public schools. The budget-slashed, rainy-day-fund-untouched Texas that our Legislature is contemplating wouldn’t be just a mean, hard place for our families to live. It would be an inefficient one, too — and one whose problems this budget will only make worse.
The proposal to cut reimbursements paid to Medicaid providers by 10 percent is pure pound-foolishness. And its horrifying long-term costs will hit us all.
For most of us, Medicaid seems far from our everyday lives; we think of it as a program that covers people who’ve been poor, or will be poor, all their lives.
But actually, Medicaid generally winds up helping people who spend most of their days in the middle class. According to the Texas Hospital Association, 50 percent – half! – of all the babies delivered in Texas are billed to the program. And according to the AARP, Medicaid covers two-thirds of the elderly in nursing homes.
“The older you get, the more likely you are to be poor,” Bob Jackson, AARP Texas state director, explained to us recently. “And nursing home care is expensive. People who’ve been good middle-class taxpayers all their lives, who never expected to be poor, end up on Medicaid.”
The 10 percent cuts would be plenty awful if they only meant that those babies and grandmas would receive 10 percent less of the medical care they need: 10 percent fewer vaccinations, 10 percent less help avoiding bedsores. But the actual effects would be even more painful — and more widespread.
Texas already runs one of the leanest Medicaid reimbursement programs – one so lean that it doesn’t cover the actual cost of treating Medicaid patients. Doctors already lose money on those patients; many simply can’t afford to accept them. And further cuts could mean that far more would have to stop accepting Medicaid.
The upshot? If pregnant women can’t find a doctor who’ll see them, they’re likely to skip prenatal care — and thus, more likely to suffer serious problems with their pregnancies or give birth to a premature baby. Those intensive-care outcomes aren’t just tragic; they’re far more expensive than prevention. And we taxpayers will end up paying for them.
Even babies and mothers-to-be lucky enough to have insurance would be affected. Medicaid cuts, the hospital association says, would cause some OB/GYN wards to close entirely. Those closures would hit rural places hardest, leaving towns without a hospital ready to deliver babies. One likely closing in the Panhandle, for instance, would mean that a woman could go into labor more than a hundred miles from a maternity ward.
The cutbacks would hit the elderly just as cruelly — and with equally little in likely cost savings. Consider Medicaid’s Primary Home Care program, which pays for an attendant to do the stuff that allows a fragile person to continue living at home: help with things like shopping, tracking medicines or bathing.
Cutting the Medicaid reimbursement makes it likely that agencies wouldn’t be able to pay those home health care workers even minimum wage, the AARP points out; and since it’s illegal to pay less, agencies would have to stop providing the service. Without home help, a semi-self-sufficient senior would likely be propelled into a nursing home — which would cost Medicaid three times as much.
Of course, that’s assuming that a nursing home could be found. Slashed reimbursements, the AARP says, means that many long-term care facilities would also stop accepting Medicaid patients. The elderly who outlive their assets – the blind, the Alzheimer’s-addled, the wheelchair-bound — would be left to shift for themselves.
Texas can’t afford to treat its babies and its elderly so badly. It’s time to tap that rainy-day fund. Spending those pennies will save us pounds. And lives.
