Frightening burdens await Mesa County 
with the expansion of Medicaid rolls

Last week it was reported that, beginning in January, up to 7,000 new folks in Mesa County will be added to the Medicaid rolls. Throughout Colorado, as many as 160,000 people will be eligible for the coverage.

For some, it’s time to break out the Vuvuzela horns to celebrate this triumph over financial reality. Others may want to be more restrained.

By others, I mean people who will be participating, administering and being paid by this program, which is to say nothing of the people who will be paying for it. This includes people still paying taxes, bond investors who don’t watch the E entertainment network to see where the country is headed and the Federal Reserve, which is helping finance the country’s great leap forward by buying its own debt.

Purchasing one’s own debt is a great scheme that’s a little bit like building a perpetual motion machine in your garage, selling it to yourself and thinking you own a business.

Let’s put cost aside for a moment, however, and turn our attention to providers and wonder aloud what the reimbursement rates for procedures and visits are likely to be in four years or so. I’m betting they’ll be less than they are now.

Some would say this is not going to be a problem because first off, the present reimbursement rates are so generous and, secondly, this issue will easily be solved then by President Joe Biden and his administration when it becomes acute, probably as a result of task force work by Vice President Anthony Weiner.

Also, what will happen if a sizable percentage of providers decide not to accept Medicaid patients at the government’s reimbursement rate? What inducements might be employed? Would admission and practice privileges at hospitals receiving federal funds be tied to physicians’ participation in government-funded programs?

What about compliance costs? The Daily Sentinel story on the announcement spotlights the unclear nature of how eligibility is to be processed through Mesa County’s Department of Human Services, which, as of last week, was still asking whether it will “have adequate resources to handle the influx of new clients.”

Don’t worry. The department is adding temporary staff to handle this permanent program and is currently training on the “data system and lingo” to deal with the increased eligibility numbers.

Ah, the lingo, otherwise known as the regulatory language with which providers will have to comply in order to receive reimbursement.

Providers can look forward to tremendous help from these temporary workers on this cumbersome and gigantic program and be confident that resources available through social service agencies will be comparable to those available for existing programs.

What about internal compliance? Diagnostic and treatment codes for insurance, Medicare and Medicaid already take up too much of a physician’s office time, and this program will undoubtedly require even more. Most physicians I know have to be forced to even look at a credit card statement, much less spend their day plowing through forms and assigning codes.

There are, however, always a few practitioners in favor of these kinds of regulatory bonanzas, who see it as an opportunity to become immersed in bureaucratic minutiae and hector others about submission issues while waving copies of the Code of Colorado Regulations.

I have to object to this usurpation of duties, as that sort of behavior belongs properly to lawyers, not doctors, thank you very much.

Let’s get back to cost for a moment. Last year, the Kaiser Family Foundation estimated Colorado’s share of the Medicaid expansion over the next 10 years to be about $858 million, according to The Denver Post. That’s with the federal government picking up 100 percent of the cost the first few years.

Also last year, Real Clear Politics reported that in 2009, the federal government paid $350 billion on direct Medicaid health care costs, or about $5,500 per recipient. At that time, the feds picked up the tab for about 57 percent of the programs.

Lots of questions and money, but don’t worry, Colorado, we have until January to figure it out.

Rick Wagner writes more on politics at his blog, The War on Wrong.


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