Surgical Cuts

How to save medicaid:

Forty-one states have contracts with Medicaid MCOs, with twenty-one of those states led by Republicans, and over 75% of those GOP-led states spending less than the national average on Medicaid. Texas and Florida have 16% of the nation’s population, but just 10% of the country’s Medicaid spending. They rely heavily on MCOs to run their Medicaid programs and are two of the most economically efficient states in the country. These states didn’t choose MCOs by accident; they realized that a managed care strategy puts constraints on Medicaid expenditures and keeps the focus on patient care. California just passed a ballot measure to implement an MCO tax that was backed by the state’s Republican Party. By passing this ballot measure, voters overwhelmingly told Governor Gavin Newsom that they want Medicaid dollars to strictly be used for healthcare. Governor Newsom opposed the measure because it reins in his ability to use creative accounting to take more federal taxpayer dollars in the name of “Medicaid” and then use that money for nonhealthcare-related budget items. Politicians in those states aren’t interested in electoral suicide, nor, as all recent elections demonstrate, are they committing it. Is it a silver bullet? Of course not. Nothing is. But it is an effective arrow in the quiver, and a bunch of effective arrows can have the same effect as a silver bullet.

The bullet must be precisely aimed...