Gov. Jeb Bush is right; Medicaid is a fiscal monster that threatens to eat Florida's lunch.

Published: Thursday, January 13, 2005 at 6:01 a.m.
Last Modified: Thursday, January 13, 2005 at 1:11 a.m.
Next year, the state's Medicaid budget is expected to reach $17 billion - double what it was just six years ago. Right now, Medicaid eats up 26 cents of every state tax dollar, and it's appetite is growing far faster than the state's revenue stream. Moreover, four out of the last five years Medicaid's actual costs have exceeded its budget.
Medicaid serves 2.3 million poor and disabled Floridians, and it's clear that without either major reforms, or significant infusions of additional revenues each year (read, tax increases) the state will be forced to either drastically cut services or restrict eligibility for the program.
Gov. Jeb Bush wants to privatize Medicaid; essentially giving Medicaid patients vouchers and turning them over to privately operated managed care companies. With his unwavering faith in the market, Bush trusts that those companies will be able to deliver the care Medicaid patients need while saving tax dollars.
"We want to empower the people in the Medicaid program to control their own health care, to choose their own coverage, their doctors and their treatments," Bush said this week. The alternative to privatizing Medicaid, he warns, may be drastic cutbacks in benefits and membership.
While agreeing that Medicaid in its current form is fiscally unsustainable, it is too soon to make the leap of faith that the key to saving it lies in privatization. In fact, the Jeb Bush era has been fraught with instance after instance in which the privatization of public functions has resulted in higher costs and less effective services.
The problem at the outset is that the governor has yet to fill in all the blanks in regard to exactly what a privatized Medicaid program would look like. There are a lot of questions to be answered before his proposal can be fairly judged.
"The governor still hasn't addressed the growing trend by large, successful corporations to shift their employees health care costs into Medicaid as a way of boosting their bottom line," Senate Democratic Leader Less Miller, of Tampa, told reporters this week. "He hasn't told us how, in a state struggling to account for the latest private contracting scandals, the private sector will be held accountable under his plan to privatize Medicaid; and he hasn't told us how his buffet-style plan will significantly save Florida's taxpayers any real money in the long run.?"
The good news in that regard is that Gov. Bush will have ample opportunity to fill in the blanks. His plan must be approved by both the federal government and by the Florida Legislature. In the coming weeks and months it is bound to be closely scrutinized by groups like the AARP, by public employee unions, by patient advocates and by the private health care industry.
Can managed care tame the Medicaid monster while still preserving patient choice and quality care? How will the state hold the industry accountable if it fails to do so? What will happen to AIDS patients or those with other chronic illnesses who require more intensive, and expensive, care than HMOs are prepared to allow? Is this just a way of getting HMOs to cut health care benefits so the politicians won't have to take the blame for it?
There's little question that the state's current Medicaid program is a budget-buster that threatens to limit the state's ability to pay for education, law enforcement and a host of other important public services. And Bush's plan to turn Medicaid over to the managed care industry deserves a fair hearing in the Legislature this session.
But lawmakers should not accept on blind faith alone the notion that the private sector is the cure for what ails Medicaid. Before making any major changes, the Legislature should insist that Bush fill in all the blanks as to exactly how privatized Medicaid would work. The wellbeing of 2.2 million vulnerable Floridians hangs in the balance.

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