Medicaid Commission adopts reform plan

Washington -- States need more flexibility with Medicaid, beneficiaries should have electronic medical records and a medical home, and long-term care might best be delivered in the home. Those are some of the recommendations approved by the Medicaid Commission at its final meeting Nov. 16-17.

Health and Human Services Secretary Michael Leavitt created the panel 18 months ago to offer the agency advice on how to reform Medicaid. Its recommendations include:

• Emphasize health care quality with enhanced matching funds for Medicaid programs that use pay-for-performance at the physician and hospital levels.
• Create Medicaid Advantage, modeled on a similar Medicare managed care program, to integrate Medicaid and Medicare benefits.
• Provide tax incentives to buy long-term-care insurance and allow health savings accounts to be used to pay for long-term care expenses.
• Provide Medicaid beneficiaries electronic medical records by 2012.

The commission approved the final recommendations 11-1, with one abstention and two absences.

Democrats quickly critical

Key Democrats and an interest group have criticized the commission and its recommendations, even though its final report isn't due until Dec. 31.

"Certainly, this commission never recognized that the Medicaid program's first and foremost responsibility is to the beneficiaries," said Rep. John Dingell (D, Mich.), the incoming chair of the House committee dealing with Medicaid. "Our greatest concern should be that we ensure that health care is accessible to them."

Incoming Speaker of the House Nancy Pelosi (D, Calif.) also wasn't satisfied with the commission's work.

"There are no cost estimates," Pelosi said. "Nor are there any estimates for how much these recommendations would reduce the number of uninsured or lower health care costs or improve the quality of care."

The Bush administration declined to work with Congress on the appointments and appointed the commission on its own, said Ron Pollack, executive director of the consumer group Families USA. "I think the recommendations are dead before arrival," he said.

Others hope that will not be the case. The panel's suggestions "are carefully bold, respecting Medicaid's role in serving low-income and disabled people, but also recognizing the imperative to improve the program and align it with 21st-century medicine," said Grace-Marie Turner, a commission member and president of the Galen Institute, which supports a free-market health system.

Read first, then react

Medicaid Commission Vice Chair Angus King Jr. said more patience is needed. "I wish people would wait to see the report before they react to it," said King, an independent and former governor of Maine.

Said the panel's chair, Don Sundquist: "This was a commission that wasn't partisan. I think they're going to be surprised when they read it." Sundquist, a former Republican congressman and former Tennessee governor, and King plan to lobby members of Congress when the report is released, they said.

American Medical Association policy supports reforming Medicaid not in isolation but in conjunction with broader health insurance reform. The AMA also supports better monitoring of quality in Medicaid, including health outcomes and access to care.

Medicaid reform needed

Dingell was noncommittal about whether he would support any specific recommendations, such as creating a medical home for beneficiaries.

"The recommendations that this commission has made are so vague that it is difficult to say," he said.

Regardless of whether Congress likes the recommendations, it should reform Medicaid instead of giving the work to the next generation, King said. "Ultimately this is a public policy matter the Congress has to resolve."

The report's timing might be a bit awkward, Sundquist said, given that Democrats will be the majority in the House and Senate next year.

"We're caught between two forces -- those who have control and those who are going to be in control," he said.