During the 2018 New Mexico Legislature a memorial (HM 9) passed to study the issue of “Medicaid Buy-In.”
Nothing makes “progressive” hearts flutter like the thought of putting more people on government dole for health care, so if Michelle Lujan-Grisham gets elected Governor you can bet legislation will be forthcoming. In fact she put forth a bill in Washington on the issue although advocates in New Mexico have their eyes on a bigger proposal the specifics of which have not been put forth just yet.
They have been busy instead collecting statements of support from local governments around New Mexico:
Medicaid buy-in gaining support👇 https://t.co/gSqkqf4GK5
— Colin Baillio (@colinb1123) October 2, 2018
Medicaid buy-in programs have been proposed in many states. The premise is that Medicaid plans would be offered on each state’s insurance marketplace, and people who don’t traditionally qualify for Medicaid could pay premiums and co-pays. It essentially allows the states to opt into a federally-subsidized “public option” as a means for the left of pushing the United States closer and closer to “single payer.”
Not much research has been done on Medicaid buy-in programs and with none of them having been enacted at the state level, it will be some time before we have good data. One group, the North Star Policy Institute in Minnesota (a self-described “progressive” think tank) noted in its analysis of a buy-in program for Minnesota:
If the federal government decided not to help pay for the buy-in at all, the only way to prevent the entire cost coming out of the state budget would be to require premiums and copays for those seeking to purchase the public option.
In other words, unlike so many of New Mexico’s big-government schemes this one could be coming out of our own pockets.
The folks at North Star peg the potential annual cost of such a program at $2.074 billion if every single eligible Minnesotan decided to buy-in. Minnesota is a wealthier state than New Mexico with a population of 5.6 million as compared to New Mexico’s 2 million or so. But, given New Mexico’s poverty and likely larger group of eligible recipients (not to mention the fact that health care entitlements usually begin with low-ball pricing estimates which then spiral out of control), we might be looking at nearly $1.0 billion annually for Medicaid buy-in here in New Mexico.
What people are not discussing about a Medicaid buy-in or Medicare-for-all is that it would exacerbate a doctor shortage and hurt the populations Medicaid and Medicare were designed to help.
About 30% of physicians do not accept Medicaid. The same percentage do not accept Medicare, and many more doctors limit the number of Medicare patients they see. (When my doc retired a few years ago I had difficulty finding a new one.)
Adding more people to either Medicaid or Medicare would force the elderly and disabled to compete with more healthy patients for a shrinking number of doctors. Economics 101: increase demand without increasing supply and you get shortages.
I think that the percentage of healthcare providers who accept Medicaid is significantly less than those who accept Medicare. One of the biggest problems with Medicaid is that it does not pay for no show appointments. To state the obvious, poor people are more likely to have transportation related problems. Medicaid recipients are much more likely to seek emergency room care for routine matters because they have such difficulty finding healthcare providers on a timely basis who will accept Medicaid.
Considering these problems , it seems illogical to want to expand the number of people covered by Medicaid. Unfortunately, logic and the American healthcare system seldom go together.