This is an archived article that was published on sltrib.com in 2011, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
The feds are looking over Utah's shoulder as it seeks ways to deal with the staggering cost of necessary health care services for the poor.
The Centers for Medicare and Medicaid Services are charged with being on the lookout for good ideas they might steal, and for bad ideas that need to be squelched before someone really gets hurt. Utah has some of each.
Utah's strained budget, like that of most other states, suffers more from the skyrocketing cost of health care than from anything else. But not as much as low-income Utahns, particularly children, will suffer if reforms shift too much of those costs onto the backs of people who cannot bear them.
On the positive side of Utah's proposed Medicaid reforms, which will require a federal waiver to implement, is the idea of assigning those covered by the federal-state program to a managed care plan and paying those plans a set amount per person to provide necessary medical care. The provision of what's called a "medical home" for each person has great promise in making better health care and lower costs a pair of goals that are not, or at least not so starkly, contradictory.
A flat per-person fee can discourage unnecessary procedures, the kind providers can be rewarded for pushing when they are paid by the piece. It can also meet each person's medical needs with the most efficient methods available, protecting an individual's health while avoiding the overuse of everything from emergency rooms to pricey specialists.
Among the more unpalatable ideas, meanwhile, is the plan to saddle Medicaid clients with higher co-payments and deductibles. Instead of the current co-pays, running around $5, the plan envisions charges to the poorest of the poor ranging from $40 to $220.
The idea, to discourage the frivolous or unjustified use of expensive medical services, is not groundless. Overutilization is a major driver of health care costs for all of us. But, for people who live at the lower extremes of the economic ladder, imposing even the smallest cost burden amounts to a denial of care, even when it is greatly needed.
Medicaid is a service for the poor. One problem with being poor is that, if you get sick or injured, effective health care may well be out of reach. If it is, then maladies that other people would soon be cured of stick around to hobble the poor, causing them to miss work, maybe even lose their job altogether, or fall behind in school, perhaps for all time.
The result: More people trapped in poverty, requiring more taxpayer-paid health care.
We can do better than that. And the federal government should see to it that we do.