by James Baker, MD

Lawmakers in over a dozen states are considering getting out of Medicaid altogether as a way of dealing with the impact of the new healthcare law on already-bad state budget deficits.

I can understand the frustration with federal intrusion into state policymaking that would lead some Texas lawmakers to suggest that approach. In doing so, you’d be freed of all of the federal rules, yes.

But you’d also lose two-thirds of the dollars that Texas uses to fund healthcare for people challenged by poverty and by disabilities.

And if the idea is that losing those dollars would be tolerable because Texas would, going forward, only focus on paying for long-term services and not on acute care, here’s the problem with that. Not one of the patients with acute problems will go away.  And when they show up at the emergency room (the only place they would have left to go), the doctors in the ER’s wouldnt (couldnt) turn them away.

So who would pay instead of the feds?

Well, the cost would shift to the local hospitals, and in turn to the taxpayers who fund those hospitals, either though increased local taxes (in the big cities) or through increased insurance premiums (throughout the state).

So in trying to send a message to Washington, Texas lawmakers who pull out of Medicaid actually end up hitting up the pocketbooks of the very taxpayers who just elected them.

James Baker is a child and adolescent psychiatrist with Metrocare Services who blogs at Mental Notes.

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