Ron Faucheux: Expanding Medicaid’s role in social services is a bad idea

Ron Faucheux: Expanding Medicaid’s role in social services is a bad idea
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Ever wonder why government is broken? Here’s a good example.

The Centers for Medicare & Medicaid Services, the federal apparatus that oversees medical coverage for 160 million Americans, has been pushing for “experimental” social services largely unrelated to health care to be part of Medicaid.

While CMS insists these additional services are “health-related,” they’re stretching the meaning of “health-related” to cover a lot of territory, from paying apartment rents and buying furniture to funding prison inmate release programs and subsidies for utilities, food and transportation. That’s a broad panoply of benefits with little or no connection to the fundamental purpose of Medicaid.

Funded by federal and state governments, Medicaid provides free medical coverage to 85 million low-income and disabled people across the nation.

The key question is not whether people in need should be helped — of course they should — but whether Medicaid, already burdened with exploding costs, should transform itself into a hub for new and potentially costly social welfare services.

This CMS experiment, called the Making Care Primary Model, will launch July 1 and run for 10 1/2 years. Pilot projects approved by the Biden administration will try out Medicaid’s new role in providing social services, among other things that more closely connect to actual health care. The pilots will debut in California, Massachusetts, New Jersey, New York, Arizona, Arkansas, Oregon and Washington.

A similar experiment, costing $650 million, started in North Carolina during the Trump administration. Some of the money was used for marketing, outreach and even car repairs. According to a Washington Post story, the project had problems with software, handling invoices and making timely payments to community groups.

There is enthusiasm in some quarters for health care entities offering a wider menu of free services. While many experts are open to the idea, some express caution. For now, “the evidence is not anywhere close to supporting these activities,” Laura Gottlieb, professor of family and community medicine at the University of California, said in the Post

An article in the JAMA Health Forum, co-authored by New York University’s Sherry Glied and Thomas D’Aunno, warns health systems and policymakers to “tread warily.” They cite “real risks” when addressing wider social needs through health care, including taking funds from other useful purposes and putting them into new programs with uncertain prospects of success.

There is reason to believe that offering more free social services won’t improve people’s health. For example, a 2018 study by National Academies of Sciences, Engineering and Medicine found little evidence that providing housing and other support for the homeless, except those with HIV/AIDS, improves health outcomes.

There is also a competence issue. Does Medicaid have the expertise and management capacity to run these new programs? The CMS website provides a picture of its current bureaucracy — an organizational chart so big that it takes 78 pages to display. That should tell you something.

The political motivation behind this effort is readily apparent to anyone who has followed similar efforts: Hide debatable new programs by stuffing them into a big, existing one. While the CMS pilots are supposed to be “budget neutral,” over the years they could become permanent and costs could skyrocket. Then, as the political game is played, legislators who vote against the added spending, even if it’s proving ineffective, will be unfairly attacked for cutting Medicaid itself.

Somebody needs to ask: To what extent do these new Medicaid social services overlap existing government programs such as food stamps, Supplemental Security Income, housing programs, transportation assistance and a variety of other federal and state programs for the poor, children, farmers, the elderly and persons with disabilities?

Americans are compassionate people. Nobody wants families and children to go without basic necessities. Unfortunately, kindheartedness is often manipulated by political interests who have an addiction to government programs, including those that don’t work or duplicate others.

With swelling deficits, debt and bureaucracies, Congress needs to scrutinize every new spending scheme. Seems like a ready-made issue for Democrats who want effective government and Republicans who want less government. Let’s see if any of them take it on.

Ron Faucheux is a nonpartisan political analyst, pollster and writer. He publishes, a nationwide newsletter on polls and public opinion.


About Mary Weyand 11640 Articles
Mary founded Scoop Tour with an aim to bring relevant and unaltered news to the general public with a specific view point for each story catered by the team. She is a proficient journalist who holds a reputable portfolio with proficiency in content analysis and research. With ample knowledge about the Automobile industry, she also contributes her knowledge for the Automobile section of the website.

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