Republicans on the House Energy and Commerce committee have released a sharp critique of Medicaid in a recently released report. While we don’t agree with everything in the report, there are some points that are spot on, which is important, as the tendency is to turn the Medicaid expansion discussion into a “for or against, Republican vs. Democrat debate” which is obviously getting us no where, and is increasingly looking like the junior high school game of dodge ball, where the last person standing wins. That ain’t gonna cut it here. In the spirit of compromise and suggestions for moving forward, we offer what we agree with and what should be done next.

Here are a few verbatim comments from the 10-page report that we find to be spot on:

• A recent study found that current Medicaid enrollees are twice as likely to report difficulty in accessing primary care services than those with private insurance. Researchers have noted: “The shortage of primary care providers in the U.S. seems to affect Medicaid patients disproportionately and more harshly.” That same study found that Medicaid patients are twice as likely to visit the emergency room as those with private health insurance – a finding reinforced by the now famous Oregon Health Insurance Experiment, where researchers found Medicaid coverage did not result in a “significant change in emergency room utilization.”
• Researchers have also found that the Medicaid program provides relatively poor quality of care and inadequate follow-up care to its nearly 60 million current enrollees.
• Medicaid patients are also less likely to receive the benefit of high-quality innovative therapies.
• …this committee will review and support policies that allow states to build upon their best practices to ensure the Medicaid program is more responsive to those who depend on this program so we can ensure their improved access to high-quality care and a better life.

Why this is important to the Children’s Mental Health Network

The joy of the Children’s Mental Health Network is that we are comprised of just about every political affiliation that exists in this country. What we share is a commitment to improving services and supports for youth with emotional challenges and their families. So don’t fall into the trap of getting locked in to a ‘Republican’ or ‘Democrat’ position. Since Congress doesn’t yet seem able to do it, we must do it through our messaging to elected leaders. The challenge of implementing Medicaid to an expanded audience through health care reform is not going to be easy, as the points from the Republican report listed above indicate. But ya don’t throw out the baby with the bathwater, folks.

It’s what happens next that is most important. Network faithful need to step it up and help your elected officials seriously explore options for improving Medicaid as we move forward with expansion efforts. Running away from expansion is not the answer.

So if the Republican subcommittee that prepared this report are serious with their statement, “The program needs true reform, and we can no longer simply tinker around the edges with policies that add on to the bureaucratic layers that decrease access, prohibit innovation, and fail to provide better health care for the poor,” then we have a few suggestions:

• Identify examples of team-based care that are working now and fund replication efforts.
• Broaden the definition of primary care to include other health care professionals such as nurse practitioners, physician assistants, midwives, behavioral aids and family partners well beyond the primary physician to lessen the burden of work and ultimately improve the quality of care.
• Emphasize and support the funding of comparative effectiveness research to identify what works best for youth with emotional challenges and their families who are receiving Medicaid, and provide billable options for those services, which most likely fall out of the mainstream of what is currently covered.

Read the report and let us know what else should be added to our list. Expanding Medicaid needs to be more than expansion for expansion sake. For you Network faithful who are liberal to the core and work with families who receive Medicaid, it’s hard to argue with the Republican points above. So embrace them and then push for action.