The Times reports that an overhaul of Medicaid is still being negotiated.

“Many federal and state officials have concluded that Medicaid, which insures more than 50 million low-income people, is unsustainable in its current form. The cost shot up 54 percent in the past five years and now exceeds $300 billion a year[…]Gov. Mark Warner of Virginia, a Democrat, said earlier this year that Medicaid was “on the road to a meltdown” and would “bankrupt all the states” if Congress did not intervene[…]Mr. Barton, the chairman of the House Committee on Energy and Commerce, said that higher co-payments were needed to “encourage personal responsibility” among Medicaid beneficiaries[…]Under current law, Medicaid officials cannot charge co-payments for children under 18 and cannot charge for specific services like emergency care. For other services and for prescription drugs, the maximum co-payment is generally $3[…]”Co-payments have not changed in 20 years, and they’re unenforceable, to boot,” Mr. Barton said.”

The Times notes that the House version of the bill includes the following changes:
¶States could charge premiums and higher co-payments for a wide range of Medicaid benefits, including prescription drugs, doctors’ services and hospital care.
¶States could scale back benefits, capping or eliminating coverage for services now guaranteed by federal law.
¶States could end Medicaid coverage for people who failed to pay premiums for 60 days or more. Pharmacists could refuse to fill prescriptions, and doctors and hospitals could deny services, for Medicaid recipients who did not make the required co-payments.
Co-payments are a critical measure than should be enacted and enforced. Effectively free is a terrible situation, as it encourages greater, more frequent, and needless consumption of services, which helps drive the cost of covering them through the roof. Ever been to an open bar? People should at least think before they run to a doctor, like the rest of us do who need to take time off work, and pay a $25 co-payment.
But a bigger problem with Medicaid is that while it helps the very poor, it does nothing to help the uninsured who don’t qualify, a frequent situation with freelancers, such as my friend Dana, who is now saddled with a $45,000 debt after her emergency appendectomy. There are many other more tragic stories that we have all heard. In 2003, there were 45 million uninsured Americans. Their tax dollars, or their parents tax dollars, help pay for others to be insured through Medicaid while they themselves remain without insurance.
I would like to see a broader, even if more limited, government health care program made available to all uninsured people, regardless of economic class, at the expense of the current system which provides excellent coverage to the very few. This would also free people to do what they want with their lives, as they woudn’t have the same pressure to work for large corporations in order to receive health insurance.
We should not only be investing in the poorest citizens on something like this. If we take measures to encourage responsible behavior, such as reasonable co-payments and monthly dues that must be paid, we have a greater case to demand expanded coverage.
(Please note, I am not advocating these changes for the very sick or the severely disabled, who will not be able to afford some of these proposed reforms.)
Full story.