Medicaid – A New Possibility
Medicaid issues are generating a robust discussion and some interesting possibilities. The discussion could benefit from some solid numbers. It is important to note that a lot of money is spent in Utah on Medicaid and other Health and Human Services issues. HHS issues already receive 24% of our total budget ($2.4 billion out of a $10 billion budget). And Medicaid grows faster than any other part of the budget.
Like most areas of the budget (education and transportation, to name just two), there isn’t enough money to satisfy all Medicaid requests. So, we have to do our best to prioritize. For Medicaid, that means the Legislature works to fund the core program. Despite Utah’s rapidly-escalating Medicaid expenditures, it is increasingly difficult to provide core services, because (1) the federal government is cutting back significantly on its contribution and (2) service providers are refusing to see patients for the amounts being offered per visit.
For these reasons, the Legislature authorized a special interim committee to study Medicaid issues and figure out how better services can be provided to more people. In the last Special Session, the Legislature chose not to fund an optional dental program until the comprehensive study had been undertaken. Later, HHS also agreed not to reprioritize its discretionary funds to cover the dental program. I believe that the dialogue generated by those decisions ultimately will be beneficial.
As I discussed in the previous post, the first draft isn’t always the best. The path we were on with Medicaid dental care clearly wasn’t working. Dentists, in large numbers, are refusing to see the Medicaid enrollees. Simply putting more money into the current program largely would have been a hollow gesture – more money sitting in an account with dentists refusing to provide the services.
But, already, shortly after the Legislature and HHS decided not to spread funding to the optional program, it looks like a third way might be emerging. The Governor might have hit upon a better path for the future regarding optional Medicaid programs – looking to Utah’s tremendous compassion and sense of volunteerism. Attempting to find solutions (or at least partial solutions) for tough issues, I have often advocated such a path.
The reality is that volunteer programs probably have to come from the CEO (e.g., Mitt Romney and the unprecedented volunteer efforts for the 2002 Olympics). Raising campaign funds immediately after his election, the Governor showed a staggering ability to command the attention and excitement of the private sector. Now, he seems to be turning those talents toward the tough issues of the State. The Governor already has located a private donor who has offered $1M to help out with the dental care, and other offers to assist are pouring in. (It really does happen. Two-months ago, I located a donor who was willing to help in another difficult arena). Were the Governor to lend some of his considerable political capital to organize an effort to (1) raise private funds for optional Medicaid expenditures and (2) entice health care providers to provide even more care in this arena, amazing things could occur to complement the Legislature’s efforts to better provide for the core program.
I am not aware that anything like this has ever been attempted in the Medicaid arena. But, based on the outpouring of concern that has been expressed for optional services, it might have a chance of working in Utah. Or, it at least might help provide a piece of the puzzle. Though I'd imagine the Governor's people are already on top of this, I will ask Legislative Counsel to explore the possibility of setting up a program to allow tax deductions for such contributions.
Of course, there's no way that private donations could replace the $2.4 billion dollars of taxpayer money that are directed toward Health and Human Service needs in Utah each year. And there's no way that private donations could even put much of a dent in just the annual double-digit caseload and inflationary growth of Medicaid. Tax revenues will continue to fund those core concerns. But, if private donations could even make a fractional contribution to the overall system, that would mean a great deal in human terms.
UPDATE (6/13/06): Information on making donations is here. And, not surprisingly, Utah was ranked first in volunteerism. It is one of our greatest assets.
Like most areas of the budget (education and transportation, to name just two), there isn’t enough money to satisfy all Medicaid requests. So, we have to do our best to prioritize. For Medicaid, that means the Legislature works to fund the core program. Despite Utah’s rapidly-escalating Medicaid expenditures, it is increasingly difficult to provide core services, because (1) the federal government is cutting back significantly on its contribution and (2) service providers are refusing to see patients for the amounts being offered per visit.
For these reasons, the Legislature authorized a special interim committee to study Medicaid issues and figure out how better services can be provided to more people. In the last Special Session, the Legislature chose not to fund an optional dental program until the comprehensive study had been undertaken. Later, HHS also agreed not to reprioritize its discretionary funds to cover the dental program. I believe that the dialogue generated by those decisions ultimately will be beneficial.
As I discussed in the previous post, the first draft isn’t always the best. The path we were on with Medicaid dental care clearly wasn’t working. Dentists, in large numbers, are refusing to see the Medicaid enrollees. Simply putting more money into the current program largely would have been a hollow gesture – more money sitting in an account with dentists refusing to provide the services.
But, already, shortly after the Legislature and HHS decided not to spread funding to the optional program, it looks like a third way might be emerging. The Governor might have hit upon a better path for the future regarding optional Medicaid programs – looking to Utah’s tremendous compassion and sense of volunteerism. Attempting to find solutions (or at least partial solutions) for tough issues, I have often advocated such a path.
The reality is that volunteer programs probably have to come from the CEO (e.g., Mitt Romney and the unprecedented volunteer efforts for the 2002 Olympics). Raising campaign funds immediately after his election, the Governor showed a staggering ability to command the attention and excitement of the private sector. Now, he seems to be turning those talents toward the tough issues of the State. The Governor already has located a private donor who has offered $1M to help out with the dental care, and other offers to assist are pouring in. (It really does happen. Two-months ago, I located a donor who was willing to help in another difficult arena). Were the Governor to lend some of his considerable political capital to organize an effort to (1) raise private funds for optional Medicaid expenditures and (2) entice health care providers to provide even more care in this arena, amazing things could occur to complement the Legislature’s efforts to better provide for the core program.
I am not aware that anything like this has ever been attempted in the Medicaid arena. But, based on the outpouring of concern that has been expressed for optional services, it might have a chance of working in Utah. Or, it at least might help provide a piece of the puzzle. Though I'd imagine the Governor's people are already on top of this, I will ask Legislative Counsel to explore the possibility of setting up a program to allow tax deductions for such contributions.
Of course, there's no way that private donations could replace the $2.4 billion dollars of taxpayer money that are directed toward Health and Human Service needs in Utah each year. And there's no way that private donations could even put much of a dent in just the annual double-digit caseload and inflationary growth of Medicaid. Tax revenues will continue to fund those core concerns. But, if private donations could even make a fractional contribution to the overall system, that would mean a great deal in human terms.
UPDATE (6/13/06): Information on making donations is here. And, not surprisingly, Utah was ranked first in volunteerism. It is one of our greatest assets.
posted by steve u. at 6/12/2006
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13 Comments:
Thanks for your last two posts that give us average citizens a window into the process.
I wish you kept your hat in the ring for Senate. I'd like to see Hatch retired, however no one currently running is worth the loss of seniority in the Senate.
Thank you both. Of course, I disagree with many of the ultimate decisions made by the Legislature (which, as you might guess, are the ones I vote against). But, overall, I'm proud of the work product.
As I read polemical pieces like Holly Mullen's or articles that are too cursory to get into the details, I get excited thinking about the level of detail and discourse that blogs can bring to an issue.
Of course, people might disagree with my reasoning or believe that I am being just as political as Holly or other partisans. If so, they have the space here to jump into the dialogue and reason together. Thanks to all who do so.
Herbert Hoover had a similar idea in regards to caring for the sick and infirm who are unable to pay. It didn't work out so well.
Charity is an essential part of being human, but the coffee can at 7/11 isn't going to always buy that needed liver. The Veterans Administration has demonstrated an efficient way for government to provide insurance for our heroes, all we need to do is properly fund it. The private sector on the other hand has done a disasterous job on funding American and business health care needs.
If the private cost of health care in the United States is lumped in with taxes, we are the most taxed individuals on earth. Believing charity will fix health care insurance and our national debt is wishful thinking.
I realize there is a lot of grousing over the parking garage and the two issues are loosely connected, but there is no question that on a Federal level, the priority of the government is not the people (regardless of seniority).
Pete,
I’m not sure you understood the post. I want to explore whether the private sector might help with 1/2000th of the cost of state-government-provided charitable programs. Not the whole thing. Using your analogy, that wouldn’t be the cost of the liver transplant; it would be the cost of the ride to the hospital. Arguing that private efforts are doomed to fail seems odd when $2M likely will be raised in a 2- or 3-week time period and in a state where many people are clothed and fed through non-governmental efforts.
Rep Steve U., I think the private Medicaid contribution creates a bad precedence for public policy. Are citizens in Utah now to expect philanthropists to bail out policymakers for not funding social programs? The problem with that in my opinion is there is no civic dialogue to determine which programs should be funded. The determination seems completely arbitrary by the one with millions, looking for tax relief and public praise.
However, I guess civic dialogue in the State Legislature resulted in funding parking over Medicaid...so maybe I’m giving the process more credit than it deserves.
James O.,
Tax deductions already are available for many of the philanthropic efforts our citizens make to help others. Dialogue occurs when determining whether to allow the deductions.
My issue isn't whether tax deductions should be provided for charitable contributions, I have no problem with that (other than the false altruism it fosters).
My issue is the policy precedent. What is next? The Legislature doesn't fund transportation then a philanthropist decides to contribute millions to transportation projects? This is fine on the surface, but who decides which projects are funded with his money…suddenly that policy decision is made by one person, instead of 104 elected officials representing all Utahns (in theory). It is a poor policymaking process.
I sorry, I don't think I'm tracking your concerns. Currently, philanthropists offer a lot of money to help with many state projects. For example, philanthropists provide a lot of funding for state buildings. The state still sets policy by deciding whether to accept the money for that specific purpose and build the building. This gives taxpayers a break (and students, since many of these buildings are on college campuses) by giving the agencies incentive to go out and drum up private sector financial support for the project.
Also, individuals and non-governmental entities give tremendous amounts of financial support to public education. I think it only helps.
I agree philanthropy has and should play a part in the overall community good, funding projects, etc. However, I think this is very different. Usually, in my opinion, these philanthropists are not driving the policy bus, elected officials are. However, this situation is reversed. The State Legislature determined the funding priorities, regardless of how wise or unwise their decisions are, there is still a process. A million dollar donation for one program does not go through this process, it is determined by one individual...which is my initial point, it creates a bad policymaking process. Who should citizens look to for leadership? Our elected officials, who we entrust with policymaking authority? Or philanthropists? In this situation philanthropy is not drummed up after the fact to provide tax payers with relief (like your example) rather the Legislature (with a billion dollar surplus) determined policy priorities, and then allowed a private party to alter those priorities. Do you really think this is the same as donations to fund higher ed buildings?
James O.,
Thanks for the clarification. I get what you're saying. But I can't make up my mind whether I agree with you.
Of course, you are correct that policymakers should control state spending and, definitely, must be responsible for that spending. However, I realize the limitations that a Legislature has (especially a part-time Legislature) to properly address the nuances and complexities of health care and Medicaid. You see how we struggle to get it right with education (though, there too, we leave most details to the State School Board and local school boards), and that is an area that doesn't change as fast as the health care arena.
So, we guide spending, but we leave a lot of discretion to Health and Human Services to tweak those priorities. For example, the Department chose to ignore the Legislature, when we suggested that a better use of CHIP benefits would be to enroll more children with slightly lesser benefits than it would be to enroll fewer children on benefits that exceed anything reasonably available to other citizens. Knowing the Department has that discretion and that it uses it when it wants, it is a silly part of this story to hear the Department say it didn't shift money to dental benefits because it was afraid of reprisals. Bull. Just as the item never got prioritized in the Governor's budget recommendations, the Department simply chose to fund other things.
Point well taken, but it will be interesting to see if the private sector steps up the next time the State faces Medicaid budget crisis.
They just might; that's what I want to explore.
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