Please ensure Javascript is enabled for purposes of website accessibility
Home / Columns and Features / Vision needed to guide
revamping of Medicaid

Vision needed to guide
revamping of Medicaid

New York’s Medicaid program, and Gov. George Pataki’s proposed cuts to it, are much in the news these days. While a lot has been said about particular budget cuts, there has been virtually no discussion about the guiding principles which inform how we should shape New York’s health care system. In turn, there has been no articulation of a vision of what the system should look like five or 10 years from now, nor how the proposed changes fit into our getting there from here. New York’s Medicaid program is very expensive, and it would be hard to argue that it could not be run more economically or efficiently. However, we should not be lulled by the problems of New York Medicaid into thinking that they are unique to this state or to Medicaid. To a large extent, some of the problems of New York Medicaid are problems of America’s health care system and of every state’s Medicaid program.
The Center for Governmental Research Inc. recently issued a report for the New York State Association of Counties that opens by citing as a major problem New York’s 12 percent annual increase in Medicaid expenditures between 1989 and 1993. While that is certainly a problem, it is actually slightly less than the national increase in all health care expenditures of 14 percent annually over the same time. Likewise, the report notes that New York’s Medicaid expenditures for long-term care nearly tripled between 1983 and 1993. Guess what? Nationally, the costs paid by all sources for long-term care during those years also nearly tripled.
These data suggest that we will not solve the problems of Medicaid by looking at that program in isolation. As we change the Medicaid program, we need to be cognizant of how each single change affects both other Medicaid services and the rest of the health care system as well.
For example, while a lot of attention has been focused on the visible impacts of eliminating various long-term-care programs such as adult day health care, little attention has been paid to the “decoupling” of the rates hospitals are paid by Medicaid and the rates they are paid by Blue Cross and other insurers. Currently the Medicaid rates and those of insurers are linked. From the narrow perspective of the state Medicaid program, it is in its interest to be able to lower the Medicaid rates while not directly affecting the other rates, for it is thus less financially harmful to the hospitals and they will mount less of a fight against such cuts.
From a broader perspective, however, this decoupling goes against what we in Rochester have long understood, that a common approach by all the payors is ultimately in everyone’s interest. Otherwise, the cuts in Medicaid end up just being made up elsewhere, i.e. by Blue Cross and the other insurers and HMOs. So what looks like a good deal for New York Medicaid and the taxpayers becomes a bad deal for employers paying for health insurance for their employees, because the costs “saved” by Medicaid just get shifted to the private sector to make up.
Likewise, there has been little discussion about whether we want to change what the CGR report describes as New York’s “more lenient income requirements than many states.” In Texas, for example, a couple living at home can only retain $211 per month for their living expenses and still get Medicaid; in New York they can retain $958 per month. We could save a lot if we ran a program like Texas’. Home care would be real cheap, since no one could keep up their home or pay the rent long enough to run up a big bill.
If we wanted to save a lot on Medicaid’s big ticket item, nursing-home care, we could do like Florida and make any patient with income over $1,338 per month ineligible for help. Since the state says the average cost of nursing-home care in this region is more than $4,100 monthly, a policy like Florida’s would clearly leave a lot of people in the lurch.
While those policies sound draconian, they are in place in very large states with lots of elderly. We have not had any serious discussion of whether we favor or oppose such policies, any more than we have about the cuts being proposed. Such a debate, of course, takes time, a commodity in scarce supply as the April 1 budget deadline looms. If we do not take the necessary time, however, we will end up with all sorts of unintended consequences, including costs cut in one sector just showing up as increases in another.
Many have long complained that New York’s health care system has been micromanaged by the bureaucracy. The current approach to the state budget is just a different sort of micromanagement of the health system, this time by the Legislature and the governor. Instead, let them first articulate their vision for the future and the budgetary constraints on that vision. Then let all those affected– patients, providers, payors–come together at the community level through the health systems agencies, and at the state level through their advocates and associations, to propose a road map for how we get there.
(Rene Reixach is executive director of the Finger Lakes Health Systems Agency.)

x

Check Also

Cybersecurity advice: keep current on employee training, changes in laws (access required)

Cybersecurity should be a top priority for any business, regardless of its size or industry, according to one legal expert.“You ...

Downtown development focused on street level experience, catalytic projects (access required)

Despite continued improvement and ample development in Rochester in recent years, the city still lacks the energetic nightlife and retail ...

The Bonadio Group (access required)

The Bonadio Group announces the addition of Christopher Wagner as assistant accountant to their staff, as well as the promotions ...

Preventing employee burnout and supporting mental health in the workplace (access required)

Among the mental health concerns that were exacerbated by COVID-19, one that impacts employers of all types and sizes shows ...

Mindless scrolling through social media can wear on mental health (access required)

Kathryn DeVinney reaches for her phone to check the weather before going outside.“Five minutes later, I haven’t checked the weather, ...

Don’t forget the golden rule in times like these (access required)

Well, it’s official – we’re now in a bear market!  Stocks, as measured by the S&P 500 Index (a proxy ...

State, city of Rochester strive for social and economic equity in cannabis industry (access required)

When state lawmakers approved the Marijuana Regulation and Taxation Act (MRTA) in March 2021, one of the key provisions in ...

N.Y. initiatives provide momentum for adult-use cannabusiness to move forward (access required)

From propagating plants to educating about equity opportunities, this summer will be anything but a time for rest for those ...

Thoughts about the recent market turmoil (access required)

Investors are currently experiencing one of the worst stock markets in years and one of the worst bond markets in ...

Cannabis ventures face getting enough startup money so entrepreneurs can reap benefits (access required)

Talk about the potential value of the legal cannabis market in New York and you’re talking big money — very ...

Seen 6/3/2022 (access required)

Seen Embrace Your Sisters  May 1, 2022 - Embrace Your Sisters raised $50,000 at their 15th annual Tea at Two ...

Bountiful careers are like well-tended gardens: we reap what we sow (access required)

I was working in a vegetable garden last week and got to thinking about how growing vegetables is akin to ...

Treat your employees more like your valued customers (access required)

"My boss goes to great lengths to recognize our longtime customers even to the point of sending gifts for special ...

Best hedge against inflation is keeping emotions at bay, trusting your plan (access required)

You have to go back to the mid-1970s to early 1980s to find inflation rates near where they have been ...

Former pro baseball player is still in a league of her own

These days, Maybelle Blair clocks her pitches in years rather than miles per hour. So, when the former All-American Girls ...

Tips for planning a business succession  (access required)

Planning for retirement and creating a contingency plan in the event of an unexpected exit from the workforce are critical ...

Succession plans critical for survival of family-owned businesses (access required)

While family-owned businesses are commonplace in the United States, those that are multigenerational remain rare gems. According to Cornell University’s ...

Is your strategic plan both strategic and a plan? (access required)

There is a lot of discussion about strategic planning in not-for-profit circles lately. Evidently, moving through a global pandemic and ...

What’s so great about the 2022 Great Places to Work? (access required)

It’s my favorite time of year: Great Place to Work just announced the 25th Fortune 100 Best Companies to Work ...

Loyalty programs – what you should know about compliance with the CPPA (access required)

From the straightforward “buy 9 smoothies, get 1 free,” to sophisticated frequent flyer programs, loyalty programs are a staple in ...

Are cover letters really necessary? Hiring professionals have differing opinions (access required)

“I’m a hiring manager at a local company looking to fill several positions. I’ve noticed that about two-thirds of our ...

Investment acumen or inside information? (access required)

If you had known, in early 2020, that you might be working from home during a multi-year, global pandemic, would ...

Opining on Dick Vitale’s courage, more Bills nicknames, stadium names

By the time he finished delivering a motivational speech that would have made Knute Rockne proud, Dick Vitale looked like ...

The importance of female mentorship, leadership, and innovation in banking (access required)

In my 10 years at Tompkins and 35 cumulative years in the banking field, I’ve witnessed the industry undergo several ...

Highland Hospital Gala (access required)

This year’s casino-themed Highland Hospital Gala raised its second highest amount ever, with more than $650,000 gross net income thanks ...

Inflation: How did we get here and what can be done about it? (access required)

If you’re in your 50s - o.k. early 50s - you probably remember a time when a gallon of gas ...

Reflections on pediatrics, the pandemic, and the Golden Circle (access required)

Imagine this: Your business has been open for only five months and is doing really well. Revenue is higher than ...

Will 2022 be the year of the vacation home? (access required)

With some COVID-19 restrictions relaxing and others already lifted, the smell of tourism is in the air. Demand for leisure ...

Transition services valuable for aging population (access required)

What do you need to stay safe in your family home, even if your home is getting to be too ...

Elder transition planning: Family mediation for older adults & their loved ones (access required)

The journey of aging is rarely a smooth one. As older adults and their families face emotional, financial and health ...

Senior living communities consider how to be more diverse, inclusive, accessible (access required)

The nation’s senior population is the largest and most diverse in history, according to the most recent census data from ...

Why is inflation so scary for my retirement plan? (access required)

Over the past decade, investors experienced a best-case scenario of relatively low inflation and strong investment returns from both stocks ...

A thoroughbred racehorse whose impact was not lost on us

It seemed like a good deal at the time – a rattletrap Ford van with more than 100,000 miles on ...

Ensuring your financial plan can withstand negative conditions  (access required)

Financial plans differ based on individuals’ incomes, future goals, age and tolerance for risk, but often unconsidered in those plans ...

Boomerang employees: tips on how to welcome team members home (access required)

Every manager at every level has experienced it — that awful feeling in the pit of your stomach when one ...

Spring cleaning: Considering program sustainability (access required)

There has never been a better time to consider the sustainability of your program activities and take action to address ...

Financial advisors can guide through tough times (access required)

With the country facing rising inflation and interest rates, as well as the lingering COVID-19 pandemic and the war in ...

Are you discriminating against employees with caregiving responsibilities? (access required)

As the world enters year three of the COVID-19 pandemic, the Equal Employment Opportunity Commission (“EEOC”) has issued a warning ...

Rochester accelerates its pace to become top tech hub in America (access required)

Rochester is on its way to becoming a national hub for technology innovation. Experts predict that it has the highest ...

A simple game for investors: How would you play? (access required)

Some years ago, financial author and advisor, Bill Schultheis, devised a simple game to illustrate the difficulty faced by investors ...

You need to improve your technology, but where do you start? (access required)

Technology is advancing at warp speed and certainly some innovations could benefit you and your company, but it’s easy to ...

Innovation advancements on display as Rochester continues to grow its technology ecosystem (access required)

From LIDROTEC, a company with patent-pending wafer dicing laser machines for the semiconductor industry to Stratio, which provides artificial intelligence ...

Milo the Dog has had a golden impact on Red Wings baseball, community

They had trained together five days a week for nearly six months in the backyard solitude of Josh Snyder’s rural ...

M&A middle-market activity: What businesses need to know (access required)

 Understanding the ins and outs, trends and activities going on in M&A markets can help businesses make informed decisions including ...

5 things to consider before deciding to work for yourself (access required)

When people ask me what I do, now that I’m out of television, I simply say, “I have my own ...

M&A lawyers keep busy despite pandemic barriers (access required)

2021 was a record-breaking year globally and nationally for mergers (combining two separate businesses into one new legal entity) and ...

Ending violent crime requires building trust between police, community (access required)

Rochester has recently been the recipient of many state, federal and private investments that create a true path for transformational ...

Former UR assistant Jay Wright continues working his hoops magic

Mike Neer likes to joke that he doesn’t get enough credit for helping Jay Wright become the best-dressed coach in ...

Four ways to prepare your business for the future of digital payments (access required)

Digital transformation continues to sweep the country — especially as more companies and their customers embrace digital payment technologies.Here are ...

Managing Our Manufacturing Plants in 2022 (access required)

There have been dramatic shifts in both the needs and the realities of manufacturing the United States over the past ...

“Rounding Errors” Can Add Up Quickly (access required)

It’s time to talk about time. For many employees, their lunch break is a time when they can step away ...

Just In Time production method becoming obsolete with supply chain issues (access required)

Just In Time (JIT) is a production method pioneered in the 1930s by Toyota Motor Corporation as a means to ...

Rochester firms embrace 3D printing for multiple purposes (access required)

Firms are using 3D printing to create unique tools, parts and other objects right here in Rochester, allowing for new ...

From mentee to mentor: the benefits mentorship provides for women in business (access required)

March marks Women’s History Month. It is a time to honor the strong, brave women who have broken down barriers, ...

Working across the ages: multigenerational teams offer multiple benefits (access required)

Quick: How long is the average career? If you guessed 40 years, you would’ve been right a few years ago. ...

Energy, dedication drive entrepreneurs at any age (access required)

Younger women who grew up with technology and worked in the gig economy may be more comfortable with the pace ...

Opining on Brandon Beane, SU hoops, a poor investment, baseball’s return

If you pressed me to rank the most indispensable Buffalo Bills of this glorious era, I’d go with quarterback Josh ...

Topics that don’t focus on COVID-19 for nonprofit leaders (access required)

For obvious reasons, COVID-19-19 and the many elements of disruption it has caused continue to dominate conversation at organizations of ...

March worldwide water, climate events are close to home (access required)

March marks two worldwide awareness events for the environment: World Water Day and Earth Hour. In Rochester, New York, these ...

Revisiting Art Schlichter’s sad tale of gambling addiction

Monday’s seismic news that Atlanta Falcons star receiver Calvin Ridley had been suspended for the 2022 season for betting on ...

Mentoring is an art passed from one generation to the next (access required)

Ahhh, what to say about the important art of mentoring? It is certainly an art and, in preparation for this ...

Protect intellectual property from the start (access required)

When it comes to intellectual property (IP), the old English idiom “penny wise and pound foolish” never goes out of ...

A loving team helped Chris Lillis ascend to Winter Olympic gold

Bernie Lillis points with pride to a framed photograph on the mantelpiece above the fireplace of his Fairport home. There ...

Three takeaways from Super Bowl ads to apply to marketing (access required)

Super Bowl ads deliver on a few recurring themes every year, and this year was no different. Whether it’s nostalgia ...

I Bonds: A rare bright spot for the income investor (access required)

Investors have a natural affinity for income-producing investments. A steady stream of investment income is comforting even if it is ...

What AG report on ‘credential stuffing’ hacks mean for your business (access required)

In January, New York Attorney General Letitia James released a report summarizing the findings of a broad investigation into so-called ...

Data privacy and security concerns with rise of online betting, gaming (access required)

As of January 8, 2022, New York State joined the ranks of more than a dozen states that have legalized ...

Potential headwinds are coming — what this means for your business (access required)

An abundance of liquidity and market exuberance in the world’s recovery from COVID-19 have made this a promising time for ...

Rochester’s Roland Williams hoping his Rams do it again

Eric Weddle is one of those feel-good stories that Rochester tight-end-turned-broadcaster Roland Williams has followed closely in recent weeks. Late ...

Default predicted for ‘troubled’ Eastview mall loan (access required)

The $210 million loan against Eastview Mall, labeled in February as "troubled" by Moody's Investor Service, has been transferred to ...

Urban League awarded $2 million for job-training programs (access required)

The Urban League of Rochester has been awarded a $2 million Growth Opportunities grant from the U.S. Department of Labor ...

Sutter will become president and CEO of LandPro Equipment (access required)

Thomas Sutter of Pittsford has been named president and chief executive officer of LandPro Equipment, a John Deere dealer with ...