Moving the goal posts on Illinois’ Medicaid expansion

By Naomi Lopez Bauman | Nov 29, 2014

Lopez Bauman

Some of the same Illinois lawmakers and Medicaid expansion advocates who promised better access to care, better health outcomes and lower emergency-room utilizations to justify expanding Medicaid eligibility in Illinois now want to backtrack on these promises. They are attempting to redirect attention away from their lofty promises and toward needing “more time” to achieve the desired goals, despite the fact that the Illinois Medicaid program’s track record was already well-established.

Previous work from the Illinois Policy Institute has detailed why the Medicaid program would not serve to reduce emergency-room visits nor improve patients’ access to needed care. In fact, Medicaid patients already faced many obstacles to obtaining doctor appointments, often waiting weeks – or even months – under the government program.

Instead of addressing the program’s deficiencies or exploring ways to give individuals more control over their health-care decisions, lawmakers decided to double down on the already-flailing program. Medicaid eligibility is now 138 percent of the federal poverty level. As a result, Medicaid rolls in the state could increase by 300,000.

Now, a new study provides even more conclusive findings on how patients fare under Medicaid expansion. This study, from the Oregon Health Insurance Experiment, is the only randomized, controlled study of the Medicaid program ever conducted. In academic terms, this study is the gold standard. The Oregon study found that, over the course of 18 months:

  • Emergency-room use by the Medicaid patients increased by 40 percent more than the uninsured control group. Not only were the increased visits to treat nonemergency ailments or conditions that could have been prevented with primary care, but the increase in visits also occurred during both normal and after-hours.

  • Medicaid coverage increases doctor visits, prescription drug use and hospital admissions.

  • Medicaid did not produce measured improvements in physical health.

Taken together, these results show that “free” care results in significantly higher utilization across the board but does little to improve health outcomes.

Even before the expansion, more than one-third of Illinois physicians had stopped accepting new Medicaid patients because of the low reimbursements and slow payments. Medicaid patients were already waiting weeks for routine care appointments and, in some cases, facing months-long waits for specialists before the Medicaid expansion. Instead of addressing the issue of patients’ access to needed care, lawmakers further expanded the program.

It is time to provide our state’s most vulnerable populations with true access to needed care. The guiding principle of reforming this outdated, inefficient program should be: How can Illinois best serve both the state’s most vulnerable populations and taxpayers, while giving Medicaid patients control over their own health care?

lllinois’ fee-for-services Medicaid program should be converted into a sliding scale premium assistance program, where nonelderly and nondisabled patients can purchase a health insurance plan, based on price, to best meet their own individual needs and preferences, as well as control their own health savings account. At a minimum, Illinois lawmakers should be willing to provide Medicaid patients this option instead of confining them to the one-size-fits-all bureaucratic approach.

Naomi Lopez Bauman is Director of Health Policy for Illinois Policy Institute. 


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