“Redesigning” Medicaid – It Shouldn’t Be Just About the Money

“Redesigning” Medicaid – It Shouldn’t Be Just About the Money

 Doesn’t it seem like each year you hear from folks like me with dire warnings about the impact of the state budget on health care, and long-term/chronic care in particular.

This has become the annual dance in Albany for more years than we’d like to count:  The governor puts forth huge cuts, and the state Legislature gets lobbied to eliminate them, or significantly soften the blow. 

In the past, both sides have “danced with who brung ‘em.”

This year, of course, is in many ways no different.

Yet, at the same time, it is massively different:   Andrew Cuomo swept into office on a platform of getting the state’s fiscal house in order, reducing the tax burden and making New York a business-friendly state.

For the newly installed Governor, that means cutting expenditures.

In Medicaid spending, he upped the ante extraordinarily.  For Medicaid, always a handy target for budget cutters, Governor Cuomo wants to slash spending by more than $3.5 billion.  That’s double the total amount of Medicaid cuts amassed over the previous four state budgets.  For long-term care providers, their share of the cuts in the Cuomo Executive Budget is equal to the aggregate impact of cutbacks they have endured in the past nine years.

Underlying this, of course, is the state’s horrible (there’s no other word, really) financial situation, with monumental deficits stretching out before us:  $10 billion this year; more than $15 billion the next; almost $18 billion the next, and, in 2014-15, $21.4 billion.  Unless something is done about it.

Governor Cuomo has taken the carrot-and-a-stick approach to those who provide care and services for the poor and for disabled individuals with Medicaid funds.  He says he wants to reform Medicaid and address its ills, and has established a Medicaid Redesign Team that right now is running around the state listening to people.  He wants this team to come up with ways to reduce spending, without presumably having an undue impact on those who need vital services.

That’s the Governor’s carrot.

The stick is that if there’s no workable plan in the end, Governor Cuomo says he will take the cuts anyway through across-the-board reductions.  The amount that the Medicaid team is supposed to “save” through redesign of the system, represents more than two-thirds of the entire $3 billion-plus the Governor wants to cut from Medicaid.

Make no mistake, I believe in reforming Medicaid and its spending.  It’s needed.  We can do better – we can spend less, be more resourceful, and still provide essential services while reducing the economic burden on taxpayers.  Getting there, however, requires some drastic changes in how the system works.  The Medicaid Redesign Team has a great opportunity before it to achieve a system that provides needed care and services more efficiently and effectively.

At the same time, there are things that trouble me.  Before getting to them, it might be helpful to look at the words of another Cuomo, from more than 25 years ago:

“President Reagan admitted that although some people in this country seemed to be doing well nowadays, others were unhappy, even worried, about themselves, their families, and their futures. The President said that he didn't understand that fear. He said, ‘Why, this country is a shining city on a hill.’ And the President is right. In many ways we are a shining city on a hill.

“But the hard truth is that not everyone is sharing in this city's splendor and glory…there's another city, there's another part to the shining city.  The part where some people can't pay their mortgages, and most young people can't afford one; where students can't afford the education they need, and middle-class parents watch the dreams they hold for their children evaporate.

“In this part of the city there are more poor than ever, more families in trouble, more and more people who need help but can't find it. Even worse: There are elderly people who tremble in the basements of the houses there. And there are people who sleep in the city streets, in the gutter, where the glitter doesn't show. There are ghettos where thousands of young people, without a job or an education, give their lives away to drug dealers every day. There is despair, Mr. President, in the faces that you don't see, in the places that you don't visit in your shining city.
--Mario M. Cuomo, 1984 Democratic convention keynote address

While I fully support the concept of Medicaid reform, I fear some of the directions we might take.  I find kinship in the words of the elder Cuomo, who understood, at least, that we need to hold out our hands to help others.

But they are of little comfort in looking at where we are today in 2011.  I wonder who is speaking for those in need.

For the poor who need health care – in a state budget that’s focused almost entirely, and coldly, on the harsh realities of addressing the state’s massive budget deficit – who speaks for them?

For frail older adults who need home care and housing -- who speaks for them?

For the thousands of persons living with HIV/AIDS – the poor, blacks and Hispanics, and minority women living in communities with few services – who speaks for them?

Yes, New York state needs a large dosage of fiscal responsibility, and, to his credit, Governor Cuomo is intent on getting us there.

But we need to be careful.

We should do all we can to avoid denying care and services to people simply because they are poor.

If we do not find a way to achieve financial stability in this state while at the same time preserving vital services that the poor need – especially frail elderly and persons living with HIV/AIDS – then what have we really accomplished?