By Gema G. Hernández

There is no question that Medicaid needs changes; however, they way our elected officials and their political appointees are proposing to reform the system will only temporarily reduce the state and federal budgets while decreasing the quality of life of entire communities. Therefore, the congratulatory editorials in support Jeb Bush’s Medicaid reform are in my opinion premature, particularly when no Capitated cost per Medicaid recipient per month has been established and the criteria to evaluate how to measure the success of the program is still in the drawing board.

It is very possible that for the first 3 years of the new and improved Medicaid program the costs will decrease as it happened in 1980, but after Managed Care Organizations captured, first, and dismantled, second, the service delivery system that exists today the costs will begin to increase at a rate higher than what we have today. Why? The answer is simple: Once the existing delivery system is dismantled government will have no choice but to continue to rely on the few Managed Care companies still standing. In addition, if Managed Care companies are allowed to assess the frailty level of their enrollees we will begin to see more and more frail individuals whether they are frail or not. This is an important point that goes along with the proposal to establish a reimbursement system tied to the frailty of the individual. But this outcome will not be seen immediately.

What we will see immediately are the effects the Medicaid reform will have on the middle class. We need to remember that the Medicaid reform has 2 actions: 1) It will decrease the overall amount of dollars now given to support services and 2) it will create a contracting system whereby unless you are a Managed Care Organization you will not be able to obtain a government contract.

The way the Medicaid reform is being portrayed we think that changes to the Medicaid program are going to impact only the poor, the frail and the elders, but in reality the changes to the Medicaid program are going to have a profound effect on the middle class. How the middle class is going to be impacted by the reform is an unintended consequence that will also drive our economy down. Think of the following: First, every Medicaid dollar generates approximately $4 dollars to businesses and private individuals that have nothing to do with health care. Rents are paid, groceries bought, cars are leased with those dollars. If the Medicaid dollars stop or are drastically funneled to one particular area of the economy this is going to create a domino effect. For example, some specialty fields in the medical profession will cease to exist because they will have a very limited demand for their services. No one is exploring this area and they should.

Unfortunately, this is not the only unintended consequence of the proposed reform. The Medicaid program is used by middle class families to protect their assets once mother or father is in need of a nursing home. If this option is gone how is the middle class going to pay for a nursing home? In addition, Medicaid is going to also impact some state workers because for years Medicaid has allowed state governments to expand their OPS jobs. As a matter of fact, the State of Florida elected officials have used the Medicaid program as the health insurance program for the OPS workers.

So before we open the champage bottle and toast to the leadership role we are playing in the national scenery let us first see the truth of what we are really celebrating, and as long as the per Medicaid recipient cost per month is not known, the criteria to evaluate the success of the new and improved Medicaid program is up in the air, the role of who is going to do the individual frailty to assessment is to be established and there are no options for the middle class to pay for nursing home care for their parents, the celebration is truly premature.