News Story

Medicaid Pays Below What It Costs To Take Care of Patients

Video highlights real issues with Medicaid expansion in Michigan

Dr. Donald Condit is an orthopedic surgeon who specializes in hand abnormalities. He would like to accept more patients on Medicaid but says he can't because the costs are too high and the reimbursements too low.

"Medicaid pays us way below what it costs us to take care of [patients]," Condit said.

He said Medicaid reimbursements are 22 cents to 25 cents on the dollar compared to what it costs to take care of a patient. Since office overhead alone is 30 percent to 50 percent, it puts a lot of pressure on doctors to stop accepting patients on Medicaid.

Gov. Rick Snyder, some state Republicans and state Democrats want to expand Medicaid coverage in Michigan, which is a key provision toward implementing Obamacare.

Dr. Condit discusses in the video below why eliminating specialty care is a costly mistake and what the nation needs to do make health care affordable again.

"The answer is to have people participating more in the cost of their care," Dr. Condid said. "It's not more government involvement ... it's individuals being more responsible for their health care."

Opponents of Medicaid expansion in Michigan point to studies that show the program has little effect on health outcomes. Physicians in the state and around the nation point to other policy options like state health plans providing catastrophic care and Health Savings Accounts.

A study on the program in Oregon published by the New England Journal of Medicine found "no significant effect" of Medicaid coverage in important health areas.

Meanwhile, other states, like Indiana, offer plans that inject more competition into the system, saving money while offering better coverage. Health policy experts also point to Direct Primary Care models, which establishes lower overhead for medical providers.

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Michigan Capitol Confidential is the news source produced by the Mackinac Center for Public Policy. Michigan Capitol Confidential reports with a free-market news perspective.

Commentary

Pontiac School District’s Financial Crisis Due to Poor Management, not Lack of Money

A review team has declared a financial emergency for the Pontiac School District, citing a quadrupling of debt to $37.7 million since 2009 and a possible violation of state law regarding payroll funding, among other issues.

The local affiliate of the Michigan Education Association, the state's largest teachers' union, blamed the problems partially on what it claims are funding cuts.

"Students and school employees in Pontiac are innocent victims of Governor Snyder's massive cuts to school funding and gross financial mismanagement by officials at the local level," Pontiac Education Association President Aimee McKeever told MIRS. "It's time our elected leaders take the issue of education funding seriously and provide our local schools with the resources they need so our children can get the education they deserve."

In fact, the problems in Pontiac seem to be solely an issue of local mismanagement and bad union bargaining agreements.

The district spends among the most in the state at $16,400 per pupil. While students fled the district, there was a 35 percent increase in average teacher salaries from $56,781 to $76,449 between 2008 and 2011, before dropping to $67,702 in 2011-12. Despite the claim there were cuts, the district received $14,125 per pupil in 2010-11, up from $13,488 in 2007-08.

Blaming the state doesn't hold water. Pontiac received $14.9 million in 2008-09 (for 6,687 students); $12.8 million in 2009-10 (for 5,491 students); and $16.3 million in 2010-11 (for 5,408 students).

And in April 2012, the interim superintendent was pleading with the union to try to avoid emergency fiscal management. Walter L. Burt wrote:

I have communicated to this community and employee groups on numerous occasions that we can no longer operate the District where expenditures exceed revenues. To this end, I met with the presidents of all of the employees groups in January, 2012 to seek their cooperation in working with administration to find ways to reduce the District's deficit. There were no proposals, or concessions, made to me about how we can begin addressing this overwhelmingly growing deficit. In each case, my plea to the union groups was rejected.

Consequently, I had no other alternative but to begin the process of "right-sizing" the district by laying off staff in administrative, secretarial, maintenance and operations and other support staff. During the initial reductions, I took every step possible to stay away from employees that provided direct instructional services to children, namely teachers.

As the year ensued, I was still optimistic that I would receive concessions from the PEA, the largest of our employee groups. Unfortunately, these concessions did not occur and I was left with no other alternative but to begin the process of laying off teachers. Let me make this perfectly clear, had employees groups agreed to concessions earlier, we could have minimized the number of positions eliminated.

On May 11 of this year, the Pontiac Education Association finally agreed to some concessions. Teachers took a 6 percent salary reduction and step increases were frozen. Previously, the district paid 100 percent of health care premiums; employees now pay any amount over the state hard cap of $5,692.50 for single person coverage, $11,385.00 for individual and spouse coverage and $15,525.00 for family coverage. The deductible for employees has risen to $200/$400 (previously the district covered that as well).

But it is way too little and way too late — the district is nearly bankrupt.

An ongoing problem with the discussion over education funding and problems for local school districts is ignoring the fact that the real issue is local mismanagement of funds. In almost every notable case, districts were continually receiving more per pupil and still overspending.

In two other districts in the news recently, a similar story emerged. Buena Vista, which was recently dissolved, was handing out 6.8 percent raises and paying 100 percent of health care premiums for teachers while shedding students. In Albion, which closed its high school, the district was receiving more funding than ever but paying employees more while losing 34 percent of its students.

For a decade, the state of Michigan was losing jobs, wealth and population, and taxpayers made big cuts in their budgets to deal with financial realty. Shouldn't government entities, funded by those taxpayers, do the same?

Editor's Note: The article originally said that the district pays 100 percent of health care premiums; that is incorrect. Previously, the district paid the full premiums, but a recent law enforces a "hard cap" and the teachers pay any amount above that. The "hard cap" is: $5,692.50 for single person coverage, $11,385.00 for individual and spouse coverage and $15,525.00 for family coverage.

Michigan Capitol Confidential is the news source produced by the Mackinac Center for Public Policy. Michigan Capitol Confidential reports with a free-market news perspective.