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Expert Opinions

Collaboration is Key to Improving Health Insurance Coverage

By Steve Love |

In 1965, President Lyndon B. Johnson signed the the Medicaid program into law as a part of Title XIX of the Social Security Act Amendments. Today, Medicaid covers one in five low-income Americans, as the majority of enrollees lack access to affordable health insurance. Each state administers the Medicaid program and must comply with federal standards. Amongst the successes and failures of the landmark legislation, misunderstandings persist.

States have flexibility in determining covered populations, covered services, delivery models and reimbursement. They are also guaranteed federal matching dollars for services to beneficiaries, so the Medicaid program is financed jointly by federal and state dollars. Due to this flexibility, Medicaid programs vary greatly from state to state.

People frequently ask me about Texas’ uninsured population, which is the highest in the U.S. Why doesn’t Medicaid provide them with coverage? Texas Medicaid healthcare only covers pregnant women, children and disabled adults, all of whom are subject to an income test. Additionally, Texas decided not to expand Medicaid under the Affordable Care Act, so many individuals that could have received coverage do not qualify.

People also ask why state payments to Medicare aren’t reduced since the Medicaid budget continues to rise. But payments do not cover the cost of the services, and many providers, especially physicians, elect not to participate. The Medicaid budget increases due to volume growth of more enrollees every year. If we examined the “per member per month” rate, it would be flat.

We should also remember that the total Medicaid expenditures will exceed $40 billion this year, but the federal government payments cover over 50 percent of that amount. Many people think this number is funded entirely by Texas taxpayers.

We all want better health, better care and better value for all Texans, but we must work collaboratively to improve coverage. We must reduce the uninsured, budget appropriate Medicaid dollars, and preserve the pre-existing protection for beneficiaries.

In August, Governor Greg Abbott named Courtney Phillips as the new Executive Commissioner for the Texas Health and Human Services Commission. We welcome her and will support efforts to improve the health of all Texans. Additionally, we thank state legislators as they prepare for the 86th Legislative Session which opens in January 2019.

Through cooperation, we will move the needle in the right direction.

Steve Love is the president and CEO of the Dallas-Fort Worth Hospital Council.