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Expanding Medicaid won't help Texans

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By CHARLES SCHWERTNER

Special to The Eagle

In recent months, Americans from every walk of life have come face-to-face with the stark realities of Obamacare: millions of health insurance policies cancelled, skyrocketing premiums, rising deductibles, and the frustration felt by anyone attempting to purchase coverage through HealthCare.gov.

Despite the scope and severity of these problems, many still feel the need to double down on catastrophic rollout of Obamacare by criticizing the Texas Legislature's decision not to expand our state's overburdened Medicaid program.

Medicaid is a jointly-funded state and federal program that serves some of our state's most vulnerable citizens: pregnant women, children, the elderly and the disabled.

Proponents of Medicaid expansion believe that extending this entitlement to more than a million new, independent, able-bodied adults would solve our state's uninsured problem and save taxpayer dollars by diverting these individuals away from the emergency room. The reality is far different.

Earlier this month, Science magazine published the results of a randomized, peer-reviewed study detailing Oregon's experience in expanding Medicaid to the same population of independent, able-bodied adults that Texas now is asked to consider. Despite showing no improvement in measurable health outcomes over the study's two-year timeframe, those enrolled in Medicaid actually were shown to use their local emergency room 40 percent more frequently than a control group of the uninsured. The factors driving this result are twofold: convenience and a lack of access to alternative primary care.

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An uncomfortable truth of American health care is that, while most people only use the emergency room for legitimate medical emergencies, many also use it for the same reason they use fast food drive-throughs and video-on-demand: it's convenient. Despite their considerable expense, emergency rooms will treat anyone who walks through the door, require no appointments, and are open 24 hours a day, something of great importance to those who either are unwilling or unable to seek primary care during normal business hours. Since Medicaid enrollees share no cost burden for their medical care, they also have no incentive to seek that care in a less costly setting.

To further complicate matters, Medicaid enrollees also are facing fewer alternative options for where to receive medical care. As rising Medicaid costs threaten funding for things such as public education and transportation, Texas has repeatedly cut payments to its Medicaid providers in an attempt to balance the state budget and keep costs under control. Since participation in Medicaid is voluntary, more and more doctors are making the economic decision simply to leave the program entirely. In 2000, more than 67 percent of Texas physicians accepted all new Medicaid patients; today that number is less than 31 percent.

Even as the number of physicians has declined, the number of Medicaid enrollees has surged from less than 1.9 million in 2000 to more than 3.6 million today. The result? Greater difficulty in accessing medical care and significantly higher wait times for those who can. Adding more than a million new enrollees to Medicaid without first addressing this issue would only fill the waiting rooms of our state's few remaining Medicaid providers, and in turn, drive people back to the emergency room in order to seek the care they need.

So what's the prescription for our state's health care woes?

The truth is, there is a big difference between health coverage and heath care. While it's relatively easy to enroll people in Medicaid or give them a card that says they have insurance, providing that individual with a robust system of providers willing to accept their insurance actually is far more complicated. As a state, we need to continue to expand our indigent health care infrastructure and offer greater incentives to those providers who serve patients in non-traditional settings, such as after-hours primary care clinics.

More importantly, Texas needs flexibility from the federal government to develop new health care delivery models that focus on incentivizing patients to seek care in the most appropriate medical setting. Options such as health savings accounts, copayments, variable benefit packages, and high-deductible emergency care plans each have far greater potential to keep costs under control and keep patients out of the emergency room than any conventional expansion of Medicaid. Each of these alternatives encourages individual responsibility by instilling a personal financial interest on behalf of the patient, asking them to consider honestly the severity of their condition before seeking care in the most costly setting possible.

The cost of treating our state's uninsured in the emergency room should be a substantial concern for all Texans, but no aspect of Medicaid expansion under Obamacare even begins to address the real problem. Those who tell you otherwise simply are prescribing the wrong medicine for Texas.

• State Sen. Charles Schwertner is a medical doctor serving his first term in the Texas Senate. Dr. Schwertner represents Senate District 5, a 10-county region of Central and East Texas which includes Brazos, Freestone, Grimes, Leon, Limestone, Madison, Milam, Robertson, Walker and Williamson counties.

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