Bill Minor’s most recent column, “Barbour’s heavy-handed tactics on Medicaid worrying”, brings to mind what Germany’s former Minister of Propaganda Paul Joseph Goebbels once said, “If you tell a lie big enough and keep repeating it, people will eventually come to believe it.”
Bill wrote, “In his June 30 statement, the MHA’s [Sam] Cameron made a point that got no attention: that the existing Medicaid Division ‘has yet to demonstrate its ability to plan, project and administer any budget.'” The aspersion cast concerning the capability of this (or any other) Medicaid administration’s ability to balance the books is a lie by omission. What’s omitted are indisputable facts.
Fact #1: When any given manager is prevented from having control over revenues or expenditures there is no way to accurately “plan, project, and administer any budget.”
Fact#2: State law and Federal law control the funding of Mississippi Medicaid as well as the rates paid to providers.
Fact#3: Beneficiaries and Providers control the amount of Medicaid products that are utilized.
Fact #4: Providers control rate setting through state legislation.
Fact #5: Because Medicaid is an entitlement, if you’re eligible, you get coverage. This adds another layer of difficulty to estimating the Medicaid budget.
Fact#6: Medicaid Rates X Medicaid Utilization = Medicaid Expenditures. Mississippi Medicaid has no control of either. Medicaid is usually intentionally underfunded or funded with some degree of smoke and mirrors.
Fact#7: Mississippi Medicaid budgets are projected two years in advance which makes it difficult to accurately predict the degree and direction of movement of a host of variables.
The columnist goes on to say, “I remember when public health director Alton Cobb and Clinton Smith headed the division with no political interference, it ran well. Maybe that’s where Medicaid reform should start.”
Fact#8: In 1970, Dr. Alton B. Cobb reported to the State Medicaid Commission and was given control over the program. He could make all cuts necessary to stay within the budget, and he did just that. By doing this he had the total support and backing of the then Mississippi Legislature to do what was necessary to stay within his $38 million budget. Alton Cobb was and is a good administrator and a fine person.
Fact#9: Today’s Medicaid program is a $4 billion program which has the future potential of financially devouring us all.
Fact#10: On many occasions Medicaid Executive Directors have been sternly reminded by the Mississippi House of Representatives Leadership that political control over the program was not only favored but a matter of pride.
Fact#11 Most Mississippi Medicaid programs have been designed through the political “squeaky wheel” approach and are highly inefficient.
Fact#12 Ninety-six lobbyists are working on legislators both day and night for more money to be paid to their clients through Mississippi Medicaid.
Perhaps the real reason “that we hear no outrage in the Mississippi news media about “[Governor] Barbour’s heavy-handed tactics” is Mississippians are finally getting both sides of the story and can see through this columnist’s spin.