Health Policy - New York State

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February 11, 2005



I've been waiting for somebody to make the point you hit so eloquently: that trends in our economy and culture make employer-based health coverage increasingly ineffective and wasteful. But as profound as the long-term implications are for our political leaders (long-term translating as, "don't hold your breath for universal coverage anytime soon"), it seems to me that your insight is critically important for our current Medicaid budget crisis.

If NYS's Medicaid budget brimmeth over because of wasteful spending, fine, cut it. But if, as John Holahan has found, it's because of higher enrollment due to deteriorating employer coverage, we have a different kind of crisis. In fact, we may be glimpsing a permanent, non-cyclical and even positive structural change. Maybe we should be welcoming these wage-earners onto the Medicaid rolls. If so, we need to find additional financing for Medicaid rather than cutting corners on eligibility, benefits and reimbursement.

Perhaps a tax on the businesses who are saving money by dropping their coverage? That would seem like the logical pocket to pick... Hmm, I seem to be backing into pay-or-play, which is not where I was headed when I started this post.

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