A wrong prescription: Dr. Bill Cassidy and healthcare policy

Dr. Bill Cassidy’s argument to vote for him in the 2014 US Senate race is basically: “Trust me, I’m a doctor.” For all I know, Dr. Cassidy is an excellent doctor. But Senator is a different job, and Dr. Cassidy’s record on healthcare policy is not good.

He has spent a lot of time repeating Republican attacks against the Affordable Care Act (ACA) or “Obamacare.” There is room for improvement in the ACA, as its supporters agree. Adding to its problems, the 2012 Supreme Court decision that upheld the Act also allowed states to opt out of expanding Medicaid (the federal/state insurance for the poor, the disabled, and the indigent elderly). Many states, including Louisiana did just that, which leaves roughly 400,000 Louisianans without health insurance who would have been covered by Medicaid under “Obamacare.”

Dr. Cassidy has a proposal for reforming Medicaid, the “Medi­caid Accountability and Care” or MAC Act. The MAC Act resembles the Republicans’ other Medicaid plans. Its main idea is to equalize Medicaid across all states with a per capita cap, which would vary by type of beneficiary. With Medicaid, some states are less generous and others more generous. But under the MAC Act, the less generous states would have no obligation to provide coverage to their poor citizens, while the generous states would be forced to curtail eligibility and deny coverage. The generous states are unlikely to punish their populations in this way, and the MAC Act doesn’t help solve the problem of healthcare access.

In contrast, the Obama Administration has been flexible for states seeking to customize Medicaid expansion. For instance, they supported the Arkansas Medicaid plan that met the demands of Republicans there. “Oba­macare” also addresses other problems about Medicaid. For instance, in order to increase participation by primary physicians, it increases their Medicaid payments to match those from Medicare.

Desperate to defend his approach, Dr. Cassidy has embarrassed himself by repeating absurd anti-Medicaid claims that Medicaid makes people sicker than they would be otherwise. This is a simple misunderstanding of statistics showing that people with low income tend to have worse health than better-off people with private insurance. Of course, Medicaid should be improved. But it’s better than nothing, and nothing is exactly what Cas­sidy’s MAC Act would leave many people with.

– Aaron Lercher

This letter to the editor originally published in the September 02, 2013 print edition of The Louisiana Weekly newspaper.