George Gibbs Center for Economic Prosperity

2010-Nov17 Pr⁠i⁠n⁠t⁠ Med⁠i⁠a: Tallahassee Democra⁠t⁠ – JMI Scholar Op-Ed on Med⁠i⁠ca⁠i⁠d Reform

By: The James Madison Institute / 2010

Tallahassee Democrat publishes JMI Senior Fellow Dr. Michael Bond’s opinion editorial on the crucial need to expand Florida’s Medicaid¬†reform pilot project as “My View: Let’s Expand Medicaid Pilot Project.”¬† Text as printed:New federal estimates show a bleak fiscal future for Medicare and Medicaid. The amount of additional money needed to cover all of these programs’ unfunded obligations for the next few decades is a staggering $89 trillion.”Obamacare” actually expanded access to Medicaid. Adding thousands more patients will saddle Florida with billions more in spending, a problem Florida’s Legislature seems determined to address. Absent any change, Medicaid’s costs will consume a third of the state budget by 2015.These fiscal issues, combined with Medicaid’s well-deserved reputation for providing a poor quality of care to its patients, make reforms critical.Fortunately, Florida has had a promising head start thanks to a pilot project in Broward and Duval counties, where the central idea was to make Medicaid beneficiaries interested and informed consumers of medical care.Now, three years into this pilot project, there’s more competition among plans. Being able to choose among them has benefited enrollees. Example: The portion of providers offering plans with no copayments has risen to 83 percent from 43 percent.In the reform’s third year, in order to attract enrollees, many plans also offered benefits not currently covered by Medicaid. Among their 11 different expanded services, the two most popular were over-the-counter drugs and the adult preventive dental care.Another important reform is trying to change the beneficiaries’ behavior to improve their own health. Each enrollee has an Enhanced Benefit Account (EBA) and may earn dollar credits by undertaking “healthy behaviors.” The funds may be used to purchase a variety of health-related products.One of the main goals was to increase the quality of care, and the University of Florida, surveying reform-plan members, found most enrollees in Broward and Duval said they haven’t had a problem finding a satisfactory doctor or nurse, that they chose their own health plan, and that their overall plan satisfaction was 9 or 10 on a scale of 1 to 10.Patients in reform plans in the expanded counties of Baker, Clay and Nassau also gave plans high marks.So, has the reform reduced costs? The initial, cautious answer appears to be yes. During the first two years of reform, expenditures in Broward and Duval Counties were lower, per member per month.Meanwhile, data on 28 measures of health outcomes ranging from blood pressure screening to prenatal care indicated that patients in the reform plans were above the national average in 14 of the categories versus nine for nonreform Medicaid enrollees. Moreover, health quality seems to be improving over time in the reform plans.While it’s still very early in the implementation of these reforms, the initial evidence suggests that they have led to more competition, better benefits, healthier lifestyles, reduced costs and better health outcomes. Based on this, Florida should continue expanding the reforms to additional counties as Senate leaders are now considering.About the author: Michael Bond is a senior fellow of the James Madison Institute in Tallahassee. He is a senior lecturer for the University of Arizona. Contact him at