Florida Times Union
“Guest column: Expanding Medicaid in Florida is a bad idea”
By Sal Nuzzo
December 24, 2014When I was 11 years old, I begged my parents for a dog.I’ll feed it and walk it, I promised.But three months later, my dad was walking the dog, my mom was feeding it and I had moved on to the next “must-have.”Every time I hear someone discuss Medicaid expansion in Florida, I harken back to that promise I made and how disingenuous it ended up being.No matter how much I meant it, reality proved otherwise.And with Medicaid expansion, no matter how much the federal government intends to make good on its promise to “pick up the tab,” the reality of the immense burden will smack good intentions in the face.The late Sen. Daniel Patrick Moynihan once famously said, “You are entitled to your own opinion, but you are not entitled to your own facts.”COLD, HARD FACTSThe facts are:¦ Florida’s Medicaid reimbursement rates are a small fraction of the actual cost of providing health care services.¦ The result of these price controls is a shortage in the number of physicians accepting Medicaid patients.¦ The resulting shortage of Medicaid physicians means longer waits, diminished access and reduced health care for the poor.¦ Medicaid accounts for approximately 30 percent of the state’s budget (and growing).Florida also faces a unique challenge in health care access — a significant and growing shortage of physicians.The facts are:¦ Florida has fewer than 85 physicians per 100,000 residents, substantially below the national average.¦ Approximately 30 percent of Florida’s doctors are older than 60 (fifth highest percentage in the U.S.).¦ Florida stands to lose roughly one-third of our doctors to retirement by 2030.¦ Florida ranks 36th in medical school students per capita, even after doubling medical school enrollment from 2000 to 2010.IT’S NOT FREE MONEYNow, we shift from facts to opinion.The proponents of Medicaid expansion argue this is “free money.” This opinion is grounded in a misrepresentation of where Medicaid money comes from — taxpayers.Proponents of Medicaid expansion say the poor need a safety net and denying them access to Medicaid is akin to letting them suffer. This opinion distorts the history of terrible access to care and even poorer outcomes among Medicaid patients, and ignores the existing safety net available.Proponents of Medicaid expansion argue that there is no alternative. This is simply not true.Florida can and should work to address the fundamental challenges in improving access to quality health care as opposed to increasing the number of people with access to inadequate insurance through Medicaid.The James Madison Institute recommended practical reforms in a 2014 Policy Brief. Florida has made some strides, but there is more to do.Medical malpractice reform is a good first step. Florida’s legal climate is consistently ranked as one of the worst in the U.S.Further, while we embrace groundbreaking technologies in the operating room, we need to be more open to addressing the same advancements in areas such as telemedicine, which can revolutionize care to underserved communities.We also must address the obscene complexities in the cost structure of care delivery.We have the opportunity to show the nation that positive reforms are possible.Doubling down on bad policy is simply that — more bad policy.Sal Nuzzo is vice president of policy for the James Madison Institute in Tallahassee.Article: http://jacksonville.com/business/columnists/2014-12-24/story/guest-column-expanding-medicaid-florida-bad-idea
