The Medicaid debate should be about healthcare – The Hill (blog)

Medicaid is among the most misunderstood public sector programs, but on the front lines of healthcare its purpose —serving as the primary health insurance for nearly 70 million Americans, 20 percent of our nation’s population — becomes crystal clear.

The National Association of Counties and county elected leaders are keenly focused on improving efficiencies and lowering costs in healthcare. We understand from personal experience — counties invest more than $80 billion in residents’ health services and another $25 billion for our 3.6 million employees’ health insurance each year — the current path is unsustainable.

Yet, we remain frustrated that the debate in Congress is fixated almost exclusively on federal budget impacts and cost shifts to state and local governments, rather than on improving people’s well-being and quality of care.

As a primary safety net provider at the community level, county leaders know all too well that someone always pays at the end of the day, and, increasingly, it is local taxpayers through county health, human and public safety services. From experience, we can predict with certainty that the proposed $830 billion reduction in federal Medicaid support will drive our residents back to high cost providers such as emergency rooms, homeless shelters and jails — or worse, the county morgue.

In response, NACo has spearheaded two signature initiatives related to healthcare in recent years. One is our partnership with the National League of Cities to address the opioid and heroin epidemic, which now kills more people than car crashes. Another initiative is a collaboration with the Council of State Governments Justice Center and the American Psychiatric Association Foundation to reverse the disturbing trend of using our jails as warehouses for people with mental illnesses and co-occurring substance abuse disorders rather than treat them with professional medical care.

County officials are dealing with these issues head-on and from all angles, from community, economic, moral and even spiritual perspectives. This leads us to implore Congress to shift focus. We should be problem solving together on how we, as a nation, provide consistent, coordinated and sustained quality care for our most vulnerable populations. This is an appropriate, fundamental role for the public sector.

Counties have long played a significant role in healthcare, supporting more than 950 safety net hospitals and over 700 nursing homes for indigent and low-income residents. Counties support two-thirds of the nation’s 2,800 local health departments and more than 750 local behavioral health authorities. In 26 states, counties also contribute to the non-federal share for Medicaid, with New York counties alone contributing more than $7 billion each year.

We have learned the hard way that federal-state-local partnerships truly matter, and when one leg of the stool is broken, the entire system becomes unbalanced. Jails have become overcrowded with those suffering from mental illnesses in the wake of substantial federal and state budget and staff cuts in public health and behavioral health support, including for state psychiatric hospitals and treatment services.

The needs and conditions of our residents remain. We’ve simply shifted the cost burden to county governments and asked our sheriffs, police, judges and even firefighters and EMTs to become behavioral health experts.

These county lessons are significant because Medicaid is the largest funder of preventive health, births/pregnancy, drug recovery and mental health treatment services. When we talk about the growing costs of Medicaid, it is prudent to remember the population being served. Of the 80 million individuals covered by Medicaid today, more than 34 million are children under 18 years old, 7.3 million are low-income elderly and 11 million are disabled. Approximately one-third are very low-income adults between ages 19 and 64, yet these same adults account for less than 16 percent of Medicaid costs. By comparison, the elderly and disabled represent 61 percent of Medicaid costs, with children at around 20 percent. In fact, 50 percent of all U.S. births are covered by Medicaid.

These numbers are sobering and represent profound challenges with real faces and families, not just numbers on a Congressional Budget Office spreadsheet.

The purpose of government is to serve residents. Unfortunately, the current debate in Congress has zero focus on improving the nation’s healthcare system, especially for high cost individuals who suffer with chronic conditions and illnesses. The result is clear from a local government perspective: Congress is now orchestrating a massive cost shift beyond the capacity of states and local communities to bear.

We have a national challenge in healthcare delivery, financing and access. We need national leadership to address the underlying issues and offer constructive solutions.

Matthew D. Chase is the executive director of the National Association of Counties.


The views expressed by this author are their own and are not the views of The Hill.

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