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Virginia Budget Challenge and the Politics of Medicaid Expansion

Posted by Chip Block on May 27, 2018 9:35 AM EDT
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As has been the case for years and as is predictable, there continues to be debate on whether or not to expand Medicaid in Virginia....

...and on how to do that.  Should there be new rules built into the requirements for beneficiaries of this great benefit?  What is the best way to do the expansion?  Is the main reason to do it tied to receipts of billions of Virginia-paid taxes being returned to the state...and the economic impact that could bring?  Is Medicaid expansion or continued policy of not expanding Medicaid in Virginia a political pawn?  Like all bold changes, what are predictable outcomes and those often unforeseen "unintended consequences"?

And certainly there are even more questions..."on both sides of the aisle in the Virginia General Assembly".

Joe asked me to comment again on the state of Medicaid expansion in the state of Virginia.  And he petitioned me to be succinct about it.  Since my previous blogs have made the case in favor of a "strategic and a boldly-changed" approach to expanding Medicaid, I will be pleased to make one simple expression of a point of view that I've tried to consistently express. Given that if all reports are correct, we are again on the cusp of a decision in the Virginia General Assembly, we should soon know the outcome and why such an outcome was determined-and undoubtedly this outcome will be influenced by one or more of the questions-or even other questions-that were the lead to this blog posting.

Traditional Medicaid is broken.  While conceived as a truly beneficial and correct offering to the populations in Virginia and other states as a government entitlement based on income, it has in fact over many years become a welfare item.  It is great benefit for a limited few citizens which is extraordinarily expensive, paid for out of precious state and federal income tax receipts and compounded by the unabated health care crisis where costs of health care increases.  Research finds year after year that much of these costs can be avoided-and the bulk of these costs can be tied to chronic illnesses largely borne by indigent and aged-both populations increasing in size as time goes by and both incented to do whatever it takes to continue to receive such a benefit.

That said, here's a conservative's (mine) simple perspective on why Medicaid should be expanded in Virginia and other states and what new elements of it should be adopted as conditions for its expansion.

1. Return tax dollars to those who ultimately pay them, Virginia taxpayers-but target these dollars to populations who exhibit evidence that they are following regimens that will reduce the cost of their healthcare and who will take actions to not only become healthier themselves but to help others in their conditions and/or peer group to do likewise.

2. Improve the quality and the cost effectiveness of health care products and services provided to this population.  "No free lunches", as they say.  But if you have a free lunch, it should be a healthy one.  And drive efforts to save money against the costs of providing healthcare services and products to this group.  Take a portion of those cost savings and re-invest them in providing financial rewards to the health provider community, the innovators who find "good enough, cheaper and more accessible solutions that work" and share some of the rewards with the members of this health care recipient group (Medicaid recipients) and reward them for reducing their healthcare costs and improving their health in general.

3.  Solicit sponsorship and support among the educational institutions of all strata and from media of all kinds to begin the process of building a bias to a health-educated culture and to promoting the value of smart health care choices and living better, healthier lifestyles.  This should be extending to lifting up and promoting and recognizing those in the citizenry who are becoming healthcare heroes by becoming healthier, sharing their success stories and who volunteer and seek to support and serve others in their condition "cohorts".  Make sure that the "health care heroes" are BOTH those who go to great lengths to promote health as health care providers but those who themselves become testimonies to better health and who also share their successes with others and challenge them to follow their leads as citizens/Medicaid-recipients.

4.  Measure and track the key learnings from those who are becoming healthier and whose healthcare costs are declining on a sustained and consistent basis.  Promote those findings and codify them as part of "healthy lifestyle recovery regimen" that can be turned into the basis of individual health recovery plans for all recipients of Medicaid help. And once this "evidence-based plan" is p[roven then make sure it is built into the fabric of the "managed care" aspect of the Medicaid system, make sure there is adherence and compliance to it for all recipients of Medicaid-eventually perhaps extending this to Medicare recipients as well".  Avoid HIPAA violations, but don't let HIPAA's rules constrain the triggers to improving general population health.

5. Lastly, follow the steps below...or improve them in a formal way so that we begin to drive meaningful, positive, repeatable and sustainable change in the health and reduced health care costs of the Medicaid recipient population:

- Build a detailed individualized Medicaid recipient action-plan

-Assign a "health coach" or care manager to assist in the adoption and compliance to the individualized Medicaid recipient action plan

-Assign a support team, or have the Medicaid recipient recruit a support team who will hold the recipient accountable, along with the coach/care manager, for adhering/complying to the plan

-Make sure the Medicaid recipient makes a commitment to the individualized plan of action

-Track activities against the individualized Medicaid-recipient action plan, make transparent to everyone

-Provide public recognition of successful recipients, let them tell their success stories and lift them up

-Provide a portion of the applicable health care cost savings to the recipients, their support teams and their health care providers and care managers/care coaches

In a nutshell, here's the "elevator pitch" for my personal conditional support for Medicaid expansion:

"NO MORE FREE LUNCHES with Medicaid.....great benefits and entitlements must be tied to those who are "truly entitled" to receive them based on their actions, performance and willingness to help others in following their lead".

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