The root cause of NY State’s high property taxes needs a “total overhaul”
A OPINION By Bob Confer
New York’s Medicaid system is the second-costliest in the nation. The total expenditure is around $94 billion per year.
The federal government funds 51% of New York’s expense, but you can readily see what you directly contribute to the program: In most counties across the state 54% to 62% of the county property tax goes towards Medicaid and many also designate 1 full percentage point of their sales tax for the program (they call it “the Medicaid penny”).
That’s a significant sacrifice by taxpayers at the local level and it is perhaps the biggest contributor to one of New York’s most dramatic and damning flaws – inordinately high property taxes.
In order to contain those costs, Medicaid needs a total overhaul. That’s been written about here on this page many times before as I’ve touched on everything from residency issues to downsizing of the program’s benefits to utilizing Medicaid funds as a basis for private insurance.
But, what I haven’t touched on before is personal and financial accountability by Medicaid recipients.
Why isn’t that a focus of the State?
It is for everyone else in their day-to-day lives.
If you are one of the 9 million New Yorkers who receives health care through your employer you know full well the pressure to cut costs and/or lessen the growth in them. You’re likely inundated with documents and edicts from your boss or insurer to get a primary care physician, have an annual physical, participate in wellness and cessation programs, shop frugally for prescriptions, and choose care venues properly.
It’s been drilled into our heads that if we don’t do these sorts of things the employer will pay more for insurance as will the employee, be it with higher premiums, deductibles, or copays.
It’s good business and personal finance to do those activities. Why waste money and pay more for anything?
But, more importantly, it’s good for the body. We should actively pursue preventive practices and good behaviors – even without the carrot of savings.
Unfortunately, that same pressure is not applied to the 7.5 million people in the state who receive Medicaid and everyone is paying dearly for that.
State officials should bring those practices to Medicaid.
Proper venue selection is critical in cutting back on Medicaid expenditures. In your insurance bulletins or employee newsletters you’ve likely been told that you should never go to an emergency room unless of course it’s an actual emergency (hence the name); you should go to urgent care. The common number thrown around is that an ER is 10 times more expensive than urgent care.
That pressure isn’t there in Medicaid and it shows. A University of Colorado study once found that half of Medicaid recipients prefer ERs over doctors and UC because they are “convenient”. That said, it is high time that a system was put into effect to limit ER use and one that is punitive for non-emergencies, so “what’s best” is chosen over “what’s most convenient”.
Similarly, insurers press their enrollees to have a doctor. Those HMOs also work with employers to strongly encourage annual physicals of their employees. Having a doctor is critical – he or she has the knowledge and skill to identify and address illnesses and set patients on the paths to better health (and lower costs). And, their practice can become the insured’s destination, rather than the ER or UC.
Penalties – and tough love consultation — should then be exercised on those who don’t participate in defined wellness programs. It’s no different than a private insurer or employer charging higher premiums to those who smoke. This is an absolute must-have for Medicaid. 24% of adults on Medicaid smoke, a rate that’s two-and-a-half times that of the privately insured. Persistence of this statistic leads to lung cancer, COPD, congestive issues, and more.
On the opposite side of punishment, there should be encouraging reward as well. Money spent well in the present can save money in the future. Like employee wellness programs, Medicaid should fully cover gym memberships, YMCA enrollments, and more to provide affected families the means to better their health. If someone is on Medicaid, they likely don’t have the financial ability to do that on their own.
All of this can only work if care is managed.
In the workplace, insurers and employers consistently educate the insured on health care, what options exist, and what is encouraged and discouraged, statements that are then repeated by the employees’ doctors.
Medicaid patients aren’t, for the most part, afforded that. They don’t have someone expounding upon the virtues of costs savings and the benefits of healthy living.
It’s time the state picked up that mantle and utilized best practices commonly used elsewhere to not only save money, but also to improve the lives of New York’s Medicaid population.
