For Immediate Release February 22, 2005
NATIONAL COUNCIL ON INDEPENDENT LIVING
2005 Statement of Values On Medicaid:
Increased Commitment of Resources with More Attention to Strengthening Home
and Community Based Services and Medicaid Buy-In Provisions Necessary to
Continue Progress
OVERVIEW
NCIL values Medicaid as the only source of health and long-term services for
nearly nine million children and adults with disabilities, as well as for
millions of senior citizens. It pays for early intervention services for
infants and toddlers with disabilities so that they can enter school ready
to learn and achieve. It provides essential supports for working age adults
with disabilities so that they can lead independent lives. Medicaid also
provides long-term care for senior citizens.
ACUTE CARE COST-EFFECTIVE AND NEEDS TO BE PRESERVED & STRENGTHENED
NCIL recognizes that Medicaid has been more cost-effective than the private
market at holding down soaring health care costs and is a cost-effective
policy response to increasing uninsurance in America. In fact, Holohan and
Ghosh, 2005 and Kaiser/HRET surveys found that while the average annual
percentage change in per person costs increased by 12.6% from 2000 to 2003
in private insurance, the average annual percentage change in the Medicaid
program only increased by 6.9%. Furthermore Hadley and Holohan, Inquiry,
2004 found that Medicaid costs 30% less for adults and 10% less for children
than private sector health insurance. One of the reasons for this is that
Medicaid spends significantly less on administrative costs than private
insurance. Accordingly, we believe that Medicaid's acute care system is an
essential safety net for all individuals and should be preserved and
strengthened.
Contrary to assertions that the Medicaid program is spiraling out of
control, experts such as Holohan and Ghosh have found that growing
enrollment in Medicaid, caused in large part by economic adversity, is the
primary factor driving increased costs. According to the Kaiser Commission's
Medicaid enrollment data, from June of 2000 to June 2003, enrollment in
Medicaid increased by 8.4 million people, from 32.2 million to 40.6 million.
(Holohan and Ghosh, "Understanding the Recent Growth In Medicaid Spending,
2000-2003," Health Affairs, January 26, 2005). Since Medicaid, in its role
as insurer of last resort, helped to provide a safety net for many who would
otherwise have become uninsured, the program should be lauded for cushioning
the impact of the recession upon the health and well being of millions of
Americans.
NEED FOR LONG-TERM CARE REFORM
However, NCIL agrees with policymakers who believe that long-term care
reform is essential to maximizing Medicaid as a force for good and as the
key to children and adults with disabilities living with dignity and
maximizing their independence. Clearly, there are aspects of Medicaid that
can be improved upon such as the bias in funding towards institutional
rather than home and community based long-term care.
Medicaid's long-term care system requires major reform, but that reform can
only take place with an infusion of additional resources to remedy systemic
underfunding.
We support bipartisan proposals to undertake a comprehensive study of how
long term care can best be delivered.
NCIL stands ready to work with policymakers to strengthen the program by
providing additional resources and extending the availability of home and
community based services and supports to everyone who wants them and can
benefit from them.
COVERAGE OF OPTIONAL SERVICES AND POPULATIONS ARE ESSENTIAL TO INDEPENDENCE
OF PERSONS WITH DISABILITIES
Reducing or capping funding for so-called "optional" services and
populations and offering governors more latitude to cut people's services
and supports is not the answer. Just because services are classified as
"optional" under Medicaid statute does not make them any less essential for
promoting independence, self-sufficiency and quality of life of persons with
disabilities.
STATE MEDICAID PROGRAMS HAVE DONE A SUPERIOR JOB CONTAINING SPIRALLING
PRESCRIPTION DRUG PRICES AND SHOULD BE REWARDED FOR THEIR COST-EFFECTIVE
DELIVERY
As evidenced by the rapidly increasing estimates of the costs of the Part D
prescription drug benefit created by the Medicare Modernization Act, the
federal government has struggled to contain the spiraling costs of
prescription medication. However, states have demonstrated a far superior
capacity for effectively containing prescription drug price inflation
through the use of tools such as multi-state purchasing pools, generic
prescription drugs and impact litigation. States that succeed in these
efforts should be rewarded with incentives - not punished with arbitrary
funding reductions.
POLICIES TO PROMOTE SELF-SUFFICIENCY THROUGH OFFERING AFFORDABLE HEALTH CARE
AS A WORK INCENTIVE THROUGH THE MEDICAID BUY-IN MUST BE EXPANDED
Since the private insurance market is inordinately costly and discriminates
against persons with pre-existing conditions and disabilities in the
services that policies offer, Medicaid buy-in programs and related work
incentives, as authorized by the Ticket-to-Work/ WIIA legislation of 1998,
are essential components of a policy that promotes self-sufficiency for
persons with disabilities. A crucial way to address the disproportionately
high unemployment rate of persons with disabilities is to utilize this
legislation to remove barriers created by the private health insurance
market to ease an individual's transition into the workforce.
NCIL Health Care Subcommittee