Medicaid is broken; making it larger will make it worse

Under the Affordable Care Act, also known as “Obamacare,” states have the option to expand Medicaid. But as history shows us, making a program bigger rarely makes it better. Medicaid is a broken program that needs reform. Until that happens and until we can be sure that Virginia taxpayers won’t be stuck with a massive bill, Virginia cannot begin to consider expansion.

Medicaid is broken — costs are out of control, bureaucracy is limiting coverage options and patients are not receiving the quality care they deserve.

Medicaid is the fastest-growing line item in the state budget, growing from approximately $3 billion in 2002 to more than $7 billion in 2012. Medicaid now consumes almost 22 percent of the state’s general fund budget and threatens to crowd out other important services.

The program is rigid, inflexible and forces patients into one-size-fits-all coverage models that decrease quality of care and increase cost.

Finally, access to care for Medicaid recipients is increasingly limited because doctors cannot afford to treat Medicaid patients due to low reimbursement rates. Medicaid recipients are not receiving the quality health care they deserve.

By these accounts, Medicaid is in desperate need of reform. Enrolling more Virginians in a program that costs too much and provides too little makes little sense. Before we consider expansion, we should fix Medicaid and guarantee that it works for the more than 1 million Virginians who already rely on it.

We also have to make sure Virginia taxpayers will not get stuck with a big bill.

The federal government has promised to cover most of the costs of expansion. But the federal government is $16 trillion in debt and has not agreed on a budget in four years. Advocates for expansion have misleadingly claimed that Virginia is missing out on “free” federal money. There is no pot of free money sitting in Washington. The federal government will be forced to borrow the hundreds of millions of dollars to pay for expansion, burdening our children and grandchildren with more debt.

And down the road, when the federal government is finally forced to deal with its spending issues, Virginia taxpayers will get stuck with this bill. Even if the federal government manages to keep its promises, the Heritage Foundation estimates Virginia could still be on the hook for more than $900 million through 2022.

Virginia gained its reputation as a well-managed state by addressing policy challenges in a deliberate and responsible way. Before we consider Medicaid expansion, we must reform the existing program and guarantee that Virginia taxpayers won’t get stuck with a bill we can’t afford to pay.

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