The Medicaid Check Up: Reasons for Reform


Committee Highlights that Reform is Necessary to Protect Benefits for Most Vulnerable

WASHINGTON, DC – Ahead of the Health Subcommittee’s hearing today on “Saving Seniors and Our Most Vulnerable from an Entitlement Crisis,” the Energy and Commerce Committee released a staff report that outlines the state of the Medicaid program today. The report offers an assessment of whether Medicaid beneficiaries get the appropriate, high-quality care their insured counterparts receive and what an expansion of Medicaid means for the program’s current gaps.  In addition, it highlights six major reasons to reform the program to better provide for the nation’s sickest and poorest.


1.     Obamacare Moves Medicaid Away from Its Nearly 50-Year Old Mission, Losing Focus on the Most Vulnerable: Rather than increasing access to a variety of affordable health care coverage choices, Obamacare could simply force nearly 26 million able-bodied Americans into the already strained safety net program, which was intended to serve the poorest and sickest Americans.

2.     Access to Primary Care is Already Strained for Medicaid Enrollees: A recent analysis found that only 70 percent of physicians would accept Medicaid patients in 2011. Additional studies have shown that Medicaid beneficiaries face more difficulties scheduling adequate and timely follow-up care after initial treatment for an illness than those with private insurance. The lack of preventive care often leads to more significant chronic care needs and higher mortality.

3.     The Medicaid Program Provides Questionable Quality of Care: Researchers have also found that the Medicaid program provides relatively poor quality of care and inadequate follow-up care to its nearly 60 million current enrollees. A recent study by the University of Virginia found, “that surgical patients on Medicaid are 13 percent more likely to die than those with no insurance at all, and 97 percent more likely to die than those with private insurance.

4.     Washington Bureaucracy Deters State Innovation that Improves Care and Reduces Costs: The level of flexibility afforded to the states has been restricted since the program’s creation, reducing states’ abilities to adjust the quickly growing program and improve care. The program’s centralized micromanagement, complex bureaucratic requirements, and outdated service delivery are often cited by the states as impeding their ability to provide the quality health coverage, patient responsiveness, and efficient administration common in the private sector.

5.     Medicaid is Susceptible to Waste, Fraud and Abuse:  The Medicaid Program has been classified as a high-error risk program and in 2011, the program generated more than $21.9 billion in improper payments – with more than $15 billion in overpayments due to eligibility review errors or lacking information. Every dollar that is misplaced or mismanaged in the Medicaid program is another dollar that could have gone to providing care for the nation’s most vulnerable – the core mission of the program since its origination.

6.     Medicaid Spending Projections are Unsustainable:  The health care law’s expansion of the Medicaid program is set to cost the federal government more than $630 billion over 10 years for a total of nearly $5 trillion. With already tight state budgets, Medicaid is now competing with other major areas of state services including those provided to the elderly and disabled, K-12 education, higher education, and other areas.

To read the report, click here.