HAVING PRACTICED health care law for nearly 33 years, I am being asked by many of my colleagues, clients and friends, “What now?” after the multitude of Trumpcare iterations failed to pass in the Senate.
Hopefully, people on both sides of the aisle will take U.S. Sen. John McCain’s advice and vet the troublesome and cost-prohibitive aspects of Obamacare and come up with reasonable, affordable solutions to improve the law. There are no easy answers to solve our country’s health care problems.
One point, however, is obvious: The cost of the current course of action is unsustainable.
I am not a proponent of the current Medicaid expansion mechanism under Obamacare. I think it is patently unfair for the federal government to fund Medicaid expansion in states that have succumbed to the entitlements being handed out by the prior administration or the pork in the Affordable Care Act (yes, Nebraska, I mean you). Entitlements of this nature are like opioids: Once you take them, they are addictive and next to impossible to stop.
In states such as Maine and Alaska, U.S. senators had no choice but to support Obamacare. Otherwise, their states would become bankrupt without federal financial support to cover the costs of their Medicaid expansion.
A state should not put itself in a position to become hostage to the politicians in Washington. Virginians should not take the easy road and accept the federal assistance to fund Medicaid expansion that Gov. Terry McAuliffe is asking us to take.
The cold, hard facts are that the federal deficit grew from $10.7 trillion to approximately $19.574 trillion during the Obama years. The Medicaid program comprised 8 percent of all federal spending as recently as 2014.
This is not a problem created by the Democrats alone — Republicans shoulder just as much blame, because unplanned, unfunded wars and the Medicare Part D program are major contributors to the federal deficit. This is not a political issue; it is one of what is best for the citizens of the United States.
The ACA is estimated to have contributed to the federal deficit to the tune of more than a trillion dollars (and growing). If more states elect to expand Medicaid, that deficit will grow into a more insurmountable mound of debt. When is enough enough?
I believe a much more measured approach would be for the federal government to provide equal assistance to the states on a per-capita basis adjusted for a variety of factors in each state, such as the size of the Medicaid population, health care costs and contributions to the federal treasury.
Each state would have a referendum in which its residents — not its politicians — would decide whether to expand Medicaid and the terms and conditions of such expansion. If voters choose such expansion, the state would provide Medicaid coverage to the expanded population. In many states, that cost would be in the hundreds of millions of dollars.
The key would be that the expansion would be paid by an increase in state taxes on a “pay-as-you-go” basis, instead of a “borrow as much as we want and kick the can down the road and let our children and grandchildren worry about it” basis. Further, all income and entitlements would be subject to this increased tax.
As an example, a tax of 2 percent (a low estimate, in my opinion) would apply to all sources of income. Recipients of food stamps, Medicaid and other entitlements would see their benefits reduced by 2 percent.
All residents of a particular state would share in the cost of Medicaid expansion. All of us must sacrifice for our country and its future, just as our ancestors did during World War II, when certain essentials such as gasoline and food staples were rationed.
We all have a duty to each other to use health care resources responsibly.
Let’s call on our state and federal representatives to act in the best interests of everyone in the commonwealth, especially our children and grandchildren.
T. Braxton McKee is chairman of the health care practice group at Kaufman & Canoles, P.C., in Virginia Beach.