roanoke.com Real Politics / Preston Bryant

Preston Bryant is a Republican who has represented Lynchburg and part of Amherst County in the Virginia House of Delgates since 1996.

The Republican Party is, for all practical purposes, the governing party in Virginia. As such, it has a responsibility to look ahead and note the challenges we’re to face on the horizon and then develop a plan to meet them head on.

Several months ago, the Speaker of the House of Delegates, William J. Howell, summoned a handful of legislative thinkers and shakers to his office to discuss the growing costs of Medicaid and its impact on the state budget. After a good roundtable discussion, he dispatched a few to better define the Medicaid challenges facing us and come up with a realistic plan to begin addressing them.

Weeks later, the team reassembled and laid on the table the hard, cold facts: Medicaid costs are growing at an alarming rate, and they’re gobbling up funds that otherwise would be invested in secondary and higher education, homeland security, and other such essentials.

In the current budget, Medicaid accounts for about 12 percent of the General Fund -- double what it was a mere dozen or so years ago.

Seen in hard dollars, about a decade ago, Virginia’s Medicaid costs amounted to about $1.8 billion. This year, it’s a $4 billion line item. In five years, it’ll be about $6 billion. We’re afraid to look beyond that. Suffice it to say it’s an ominous forecast.

So how did Medicaid get to be the costly behemoth it is? And how are we going to control it?

Well, perhaps a history lesson is in order, just to put it all into perspective.

In the mid-1940s, both President Roosevelt and President Truman laid the groundwork for a national program to ensure good medical care for the elderly. In a couple States of the Union addresses, Roosevelt spoke in generalities about the need for such a comprehensive plan for seniors’ care. And upon FDR’s death, Truman carried the idea further and began working on details. For nearly 20 years, bills were batted about in Congress, with none passing that did anything substantial.

Finally, in the early 1960s, President Kennedy started making headway with Congress on the issue. And after his untimely death, it was President Johnson who pushed onward to secure a national health insurance program for pensioners. In 1965, Johnson traveled to Independence, Mo., to sign into law the bill establishing the Medicare and Medicaid programs. Truman was at his side; Roosevelt was there in spirit. In 1972, the program was expanded to include more cash layouts for the poor, blind, and disabled. It was President Nixon who signed these broader Medicaid benefits into law.

From the beginning, Medicare was to be a federally run program for seniors’ health care, and Medicaid was to be federal-state partnership for both the financing and administration of medical assistance for the poor and disabled.

Both Medicare and Medicaid have grown wildly beyond 1965 estimates. The federal government continues to battle rising Medicare costs, while the states focus on dealing with the exorbitant Medicaid increases that the feds are evermore routinely pushing down to them.

Let’s recall that Medicaid’s mid-'60’s beginning was defined by a budget of about $1 billion to cover a mere four million people. Today, its spending tops $200 billion a year to cover nearly 40 million Americans.

It’s a big, expensive program. Its out-of-control growth is killing state budgets. And something’s got to give.

When Howell’s group began putting pencil to paper, two things became clear. First, people’s view of Medicaid has changed. No longer is it seen as a "safety net" program to catch those whose own financial lifelines break; instead, it’s being seen -- and increasingly used -- as their primary old-age care plan.

Second, because it’s turned into a primary care plan, much of Medicaid's exploding costs are wrapped up in payouts to nursing home operators. So if you can take the strain off of nursing home costs, logic has it, then you can begin getting a handle on Medicaid generally.

Howell realizes that Virginians -- indeed, all Americans -- need to change their behavior for these costs to be controlled. They need to be reminded that Medicaid is for the poor and disabled -- not for the middle class who under normal life conditions can plan for their own old-age security.

Today, Virginians and Americans, without shame, arrange to give away to their kids their assets in order to “impoverish themselves” so that they qualify for maximum government assistance. These once moderately well off people purposefully redefine themselves as destitute.

They’re not doing anything illegal, mind you. On the contrary, it’s a self-propelled descent to the poorhouse that’s perfectly legal. It’s the black-letter law that’s allowed folks over time to see Medicaid in a more liberal, not to mention selfish, light. And as a result, we’ve got folks of substantial means artificially swelling the Medicaid roles, inflating the costs, and thus taking away the resources meant for those who truly can’t take care of themselves. It’s the toothy haves elbowing the dentured have-nots for that last can of applesauce.

Let’s face it. Everybody wants to be secure in their retired years. But to get that security, we shouldn’t have to revert to our most selfish instincts.

That’s why Howell and his cohorts want to encourage more Virginians to purchase long-term care insurance. It’s a reasonable and cost-efficient way for those with modest means to secure the old-age peace of mind they want without redefining themselves as something they’re not.

To do so, however, will require both carrots and sticks.

First, Howell wants Virginia’s government to lead by example. He wants the state government, as an employer, to broaden its policies to allow more former state employees to purchase long-term care insurance at the same favorable group rates now available to current state workers.

A second carrot Howell would offer up is state tax credits for long-term care insurance premiums. If we really want to change citizens’ behavior -- encouraging them to prepare their own retirement plans instead of relying on state assistance -- then there are few more effective incentives than tax credits. The tax-credit costs incurred by the state today pale against the Medicaid costs we’re bound to incur down the road.

And in addition to these, Howell wants the feds, who set Medicaid eligibility rules, to let Virginia administrators more closely scrutinize those applying for state assistance. He wants Virginia to join Connecticut, Massachusetts, and Minnesota who are currently seeking federal-government permission to delay Medicaid benefits to those who are otherwise able to pay for their own long-term care.

Offering up a private-sector solution to a big government problem is perfectly in keeping with Howell and his ruling GOP’s conservative philosophy. Encouraging Virginians to make better use of private long-term care insurance will take the pressures off a Medicaid system that’s bound to break apart if nothing changes.

Howell plans to give a hearty push for these measures in the 2004 General Assembly session. Let’s hope there are enough brawny delegates and senators who’ll push with him.

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