Plenty of blame, too few solutions to Medicaid mess

Published 6:00 am Monday, February 28, 2005

Mississippi’s Medicaid program may not yet be broke just yet,but it is certainly broken.

The state agency, on the verge of being unable to meet itsobligations, took out a $50 million loan last week to keep it inbusiness through March 11.

$50 million for less than three weeks. Something is wrong.

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And $50 million is but a drop in the bucket when you considerthat Medicaid’s budget for fiscal 2004 was $2.885 billion,of which the state was responsible for $419 million.

Something is definitely wrong.

Blame for the Medicaid mess is widespread and well-deserved.

During the administration of former Gov. Ronnie Musgrove, thestate rapidly expanded Medicaid eligibility. Now, Mississippiansearning up to 135 percent of the federal poverty level can qualifyfor Medicaid.

Using federal Department of Health and Human Servicesguidelines, that means a family of four earning $18,850 annuallyqualifies for Medicaid in Mississippi. With the federal minimumwage at $5.15 an hour, employees making nearly twice the minimumwage qualify for Medicaid. Quite generous for a state that can illafford it.

The result of this “generosity” is 780,000 Mississippians -that’s nearly a quarter of the state’s population – enrolled in thestate health program.

The irresponsibility of throwing the gates to Medicaid wide openlikely will linger into perpetuity, as rarely do those on thegovernment dole ever come off.

Also deserving a slice of the blame for Medicaid’sout-of-control costs is the U.S. pharmaceutical industry.

Prescription prices account for a mammoth portion of Medicaidexpenditures, prices inflated by practices of both the industry andthe government.

Seldom can you read a magazine, watch TV or even drive thehighways without seeing ads for the latest, greatest prescriptioncure.

Today’s purple pill. The little blue pill. Drug makers are soaggressive in advertising these days that customers are askingtheir doctors for medications by name.

Where Alka-Seltzer or Tums might have cured heartburn, patientsare demanding Nexium instead. Where aspirin and Tylenol have easedarthritis aches and pains for generations, consumers began askingspecifically for Celebrex or Vioxx.

Both the advertising costs and the cost of supplyingpatient-demanded (and industry-driven) prescription medicationscost the Medicaid system and the taxpayers immensely.

So blame for Mississippi’s Medicaid mess lies both with thegovernment and with private industry. But a significant portionalso lies with individuals who refuse to take personalresponsibility.

Although there are many who cannot fully take care ofthemselves, there are many who simply will not. Cannot and will notare vastly different.

Medicaid, like so many other government programs, was meant tobe a fallback, not a way of life. Unfortunately, abuse of thestate’s Medicaid system runs rampant. Those who can take care ofthemselves should –┬áno buts about it.

Pointing fingers and defining the problem is the easy part. Whatlawmakers are now faced with is finding a solution. Like it or not,they must – and they’re running out of time.

At this point, with Medicaid poised to slide so deeply into thered, it seems no would-be solution can generate the enormous amountof money needed to keep the program afloat. But it must stay afloat- even if modified – and every bit of cost-cutting and extrarevenue will help.

Perhaps the state will consider buying prescription medicationsin bulk, limiting prescriptions or visits to the doctor, or even astricter financial means test to save program costs.

On the revenue-generating side, the all-too-real probabilityexists that fees and/or taxes paid by the residents of Mississippiwill have to be raised. But tax increases should not be theautomatic first solution, and tax increases should be off the tableunless and until every conceivable cut that can be made has beenmade first.

Mississippi’s lawmakers face tough decisions on Medicaid, buttax increases alone are not the answer. It’s all too easy for agovernment to spend itself into a problem, but it’s easier saidthan done to tax itself out.