To Insure or not to Insure?

Recently, Texas has been in the spotlight regarding their decision to opt out of measures that would expand the state’s Medicaid program. “Obamacare” would add an estimated $17 million Americans to the program, 2 million of them residing in Texas. Governor Rick Perry argues that although the program would result in $100 billion in federal funds and $1 billion in revenue for managed care organizations, Texas would be required to put up $27 billion, an amount that he believes will eventually bankrupt the state. Unfortunately, the Supreme Court voted to allow states to block Medicaid without a penalty (Businesses will push Perry to rethink Medicaid expansion rebuff).

Texas, with one in four individuals going without health care coverage, has the nation’s highest rate of uninsured citizens as well as one of the most restrictive Medicaid programs. Supporters of the program have reevaluated Texas’ share of the cost, proposing that the state would only be required to spend $16 billion over the next ten years for the program’s expansion. The federal government will pay 100% of the cost for the first three years, but only 10% after the three years have passed (Fewer Texas doctors willing to accept Medicare, Medicaid patients because of low pay, red tape).

Without health care coverage, individuals that need medical attention are opting to skip doctor’s visits. Unfortunately, without early intervention, these individuals eventually end up in the emergency room, where they are ensured access to care, but at a high cost. I believe that the government is spending more on these ER visits than it would if it would agree to Medicaid expansion.  

To add fuel to the fire, more and more doctors in Texas are refusing to accept Medicaid for the poor and elderly. This may be due to complaints of low pay (some say Texas Medicaid only pays half of the actual cost of most services) and time spent pushing paper. I believe that all of this red tape is causing doctors to focus on administrative issues rather than the quality of patient care. Also, more and more Texas medical students are leaving the state to complete their residencies due to the lack of positions in Texas. Therefore, Texas is faced with fewer doctors, and even fewer of them willing to accept Medicaid patients. This seems like a never-ending, vicious cycle to me (Can Medicaid expand in Texas? That questions lingers).

So, what are our options? Some argue that if individuals are willing to opt out of health care coverage, then the individual, not the state, should be responsible for their care. If this is the case, then these individuals should not be penalized, as I believe their burden will be heavy enough. Others argue for a co-pay system, a cost-sharing program that will also result in patient responsibility for their coverage. Regardless, individuals should be required to take active participation with regards to their health care. If Medicaid is expanded, and individuals are able to qualify based on their yearly income, then what incentive is there for them to better themselves? Children raised in low-income families on Medicaid will likely grow up with the same frame of mind. While I believe that no one should be denied access to health care, I argue for a system that would require those individuals on Medicaid to take active steps to eventually be able to provide for themselves.