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The
continuing escalation of Medicaid costs at the
federal and state level has become the focus
of much nationwide concern and discussion. At
all levels of government,
policymakers are attempting to contain
Medicaid costs while making the Medicaid
healthcare program a more flexible and
responsive service delivery system for their
most vulnerable populations.
Much
of the news over the past year has focused on
Medicaid expenditure growth, particularly in
states whose programs are consuming on average
22 percent of their state budgets. Reports
indicate that in some states state Medicaid
spending is eclipsing state spending on public
education.
While
Virginia's Medicaid expenditures in the
current FY 2004-06 biennium have grown faster
than originally anticipated, ongoing efforts
to control costs in the program have resulted
in growth rates lower than the double-digit
increases experienced in other states - 7.1
percent in FY2005 and 3.8 percent in FY 2006.
Even so, Virginia's Medicaid program comprises
about 14 percent of the state's general fund
budget.
Unlike
other states,
Medicaid is not eclipsing our expenditures for
public education. While Virginia's Medicaid
expenditures are projected to increase by $500
million in the next biennium, policymakers
need to be mindful that cost containment
measures alone will not address the underlying
issues -utilization and inflation - impacting
Medicaid's continuing growth rate. They also
must understand that reforms can not be
implemented without looking at how these
actions affect the access to and the quality
of the healthcare available to the vulnerable
citizens who are eligible for and need
Medicaid services.
Developing
solutions to address the current Virginia
Medicaid program presents a tremendous
challenge and, more importantly, many
opportunities. In the past, Virginia has been
a leader in developing cost-effective
approaches to the delivery of Medicaid
services while avoiding many of the pitfalls
that have plagued other states.
Virginia's
implementation of the Medicaid Preferred Drug
List to better manage the growth of
pharmaceutical costs is the most recent
example. In our Commonwealth's tradition of
providing leadership, Virginia House of
Delegates Speaker William J. Howell has
created a House Republican Caucus Task Force
to research, consider, and suggest possible
reform initiatives for Virginia's Medicaid
program.
As
the appointed chairman of this legislative
task force, it is my belief that there is no
need to "reinvent the wheel" in
addressing the complexities of this program.
Many organizations -- such as the American
Legislative Exchange Council, the National
Conference of State Legislatures, the National
Governors Association, the federal Medicaid
Commission, and other stakeholder groups,
including consumers -- have worked on this
issue and their work will provide the task
force a wealth of information on which to base
potential legislative recommendations for
Virginia's Medicaid program.
The
work of the task force will be to research
such previously referenced recommendations and
identify and propose policy initiatives
including, but not limited to, the following:
(1)
consumer-directed, community-based care
programs
(2)
health savings accounts or an HMO for Medicaid
recipients
(3)
long-term care insurance tax credits so
families have easier access to affordable,
private LTC insurance
(4)
disease management strategies to improve the
health of beneficiaries
(5)
fraud controls so resources and services reach
those who truly need it
(6)
cracking down on asset transfers so Medicaid
protects those who need it most, (not "medicaid
for millionaires")
(7)
electronic medical records to ensure more
accurate and better quality of care
(8)
electronic benefits transfer for services to
improve system efficiencies,
(9)
purchasing pools for small businesses to
expand access to health care.
For
any of these types of recommendations to be
seriously considered, it is crucial that they
not be implemented at the expense of access to
high quality healthcare care for those that
truly need it. Virginia's Medicaid program can
be improved through innovative strategies that
abandon the traditional "one size fits
all" mentality of the current system.
System efficiencies through the use of
technology must be implemented to better
address the health needs of the citizens, to
reduce burdensome, unnecessary bureaucratic
red tape, and to address any waste or fraud
that might exist within the current program
framework.
Finally,
the federal government must empower the states
to customize their Medicaid program to best
meet the needs of its citizens.
If
permitted to do so, I am confident that, by
working together, the consumers, advocates,
health care providers, Medicaid program
administrators, and legislators will formulate
appropriate reform initiatives that improve
Virginia's existing Medicaid Program.
--
Sept. 19, 2005
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