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House Speaker Bill Howell says he doesn’t really believe anyone is better off without insurance despite his shrill criticism of Medicaid.
Monday, March 25, 2013
Millions of Americans will finally have access to adequate medical care next year under an expansion of the government-funded Medicaid insurance program. As Virginia leaders debate whether to participate, it’s disheartening that House Speaker Bill Howell is spreading misinformation that could frighten needy families, including those who already qualify, into opting out of the program.
In a column last week on the conservative blog Bearing Drift, Howell argues that “uninsured people are receiving better care than people on Medicaid.”
It’s a shocking statement, particularly given the fact that a majority of current Medicaid recipients are children. Does Howell really believe that more than 600,000 children in Virginia would be better off treating their ear aches, asthma and broken bones at free clinics and emergency rooms?
In an interview, Howell said the statement was “more of a rhetorical question,” adding, “I don’t think anybody is better off without insurance.”
Howell’s column parrots conservative commentators who pounced on a 2010 study by researchers at the University of Virginia. They found that Medicaid patients had poorer outcomes when hospitalized for certain surgeries compared to privately insured individuals and even to the uninsured. Outcomes were measured by in-hospital deaths, length of stay and medical costs.
Howell admits he didn’t read the study, which also found that Medicare patients spent more time in the hospital and had higher costs than the uninsured.
The results are driven by differences in the groups being studied. The uninsured are a diverse group. Some are truly sick, but many are younger workers in entry-level jobs who are relatively healthy and hoping to win promotions and medical benefits before the aging process and bad habits close in.
Medicaid patients are by definition indigent, and many are gravely ill. Adult members of a family of three are eligible only if their household income falls at or below $5,727 annually. Less restrictive rules apply to children and pregnant women. Most adults, however, join Medicaid only when they become disabled or their diseases are so advanced that they lose employment, insurance if they had it, and a paycheck.
UVa researchers acknowledged that their study did not control for all of the factors affecting medical outcomes. They noted that Medicaid patients are more likely to have depression, psychoses and cancer that has spread through the body. The researchers speculated that Medicaid patients may remain in the hospital longer because they have less support and resources at home. Hospital officials might also be more likely to help a patient with a serious illness fill out the extensive paperwork for Medicaid enrollment.
Howell said he was trying to make the point that “Medicaid does not serve its patients as it should.” On this we agree. But he uses the system’s flaws as an argument for refusing an expansion that would allow Virginia to collect billions of federal dollars that could be used to reform the program and implement efficiencies.
No private insurance company would offer coverage exclusively to indigent people who are chronically ill and disabled. It’s no wonder that Medicaid, then, is imperfect. Expanding the program would broaden the pool to include younger adults and provide preventive care in an effort to keep them healthy. Howell says the the nation cannot afford to shoulder the cost, which he fears will eventually be shifted onto the state. But there is a cost, too, to leaving an estimated 400,000 Virginians without access to medical care until they are feeble and destitute. The UVa study underscores the weaknesses in that model.
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