I recently attended a Darke County Chamber meeting called the “State of the State.” Speaking at the meeting were: Ohio Rep. Jim Buchy, Ohio Rep. Dick Adams, Ohio Sen. Bill Beagle and Ohio Sen. Keith Faber. They discussed issues ranging from the state budget, November 2011 Ballot Issues (including Issue 2-Senate Bill 5), and a number of other items and issues in between.

I was surprised, but not shocked to hear that Medicaid and our prison system represented the spending needs for approximately two-thirds of all the money collected from the citizens of the State of Ohio. Medicaid is the highest single line item. It currently stands at 39 percent of the entire budget.

“Now, the rest of the story!”

The 39 percent is not the cost of Medicaid. The Federal government matches the Ohio expenditures. That is not the end of the story… During the Strickland Administration a “franchise fee” was levied against hospitals and nursing homes based upon the total annual expenditures of these organizations.

That fee, also known as a tax, allowed the State of Ohio to leverage additional matching funds from the Federal government. That is still not the end of the story… Reimbursement to hospitals for Medicaid patients average about 30 to 35 percent depending upon your location and hospital size throughout Ohio. What that means is that hospitals cost shift what they do not get reimbursed for Medicaid services to patients with commercial healthcare insurance.

So, the “rest of the story” is that Ohioans pay more than the entire State of Ohio budget for Medicaid services. Your expenditures for Ohio taxes, your expenditures for Federal taxes earmarked for Medicaid reimbursement to each state and your expenditures for your commercial health insurance add up to more than 100 percent of Ohio’s annual budget. This expenditure covers about 15 percent of the population of Ohio.

Actually, there is still more to this story. People actually think that Medicaid is healthcare for the less fortunate in our population. That is only partially true. The intent of Medicaid was to provide healthcare to those people at or below poverty. I will have to say that the majority of those receiving Medicaid benefits are people not able to afford healthcare for themselves or their dependents.

A significant minority of Medicaid recipients treat it just like they do all of the other “free” services from local, state and Federal sources. Medicaid is a never ending storehouse of free money for health related issues for this group. It is the most liberal health insurance policy on Earth because everything is free and it is virtually impossible not to qualify for any health related services you demand, regardless of real need. All you need to know is how to “game the system.”

One of the more popular long term games is for retired people to move all of their assets to relatives and friends. Within a period of about three years you can then declare that you are indigent and be put on Medicaid. You really do not have to change your lifestyle much, just who has legal ownership of your assets. Your assets are not diminished by paying for any healthcare.

The most popular abuse is the hospital Emergency Department. Medicaid recipients have or can be assigned to a primary care physician. The physician can be used for health and wellness services, including free mammograms, inoculations for dependent children, nutritional instructions and a variety of other services. The problem with the offered services is that they must be scheduled.

A Medicaid recipient can drop into the local Emergency Department, at their personal discretion, 24 hours per day and 365 days per year. The cost of the Emergency Department compared to the physician’s office is in the neighborhood of 10 TIMES as expensive.

In addition to inappropriate use of the Emergency Department there are numerous abuses that compound the already expensive visit to the hospital. Emergency Department doctors know all the myriad abuses of their department by far too many Medicaid recipients.

A call to 911 with made up symptoms of a heart attack will get you a free ambulance ride to the hospital, in addition to the free hospital care. Since you do not have any money, the hospital then has to find a way to take you back home, at their expense. In between the 911 call and getting a ride back home, the person has consumed $1,500 to $2,000 of Medicaid services. That presumes the person was not in the hospital for a valid medical condition.

One of my doctors tells the story about a single woman with five children that was a “frequent flyer” in his E.R. at another hospital. She or one of her children would have some catastrophic illness like a cold. She would come in with all of the children because she did not want to pay for a baby sitter. Also, she did not want to try to watch all the children while the sick one was being treated, so she made up a story that all of the children were sick. Each was seen by the doctor and was watched by nurses during the treatment.

Drug seeking has become an art among some Medicaid recipients. The highest number of complaints that I receive from patients at Wayne HealthCare come from people believing they received inadequate treatment for the “extreme pain” they were enduring. Also, we would always fail to give them an “appropriate” supply and strength of pills to hold them over until they can get to their “regular” doctor. Of course, they never see their regular doctor. The listing of abuses goes on and on.

So, what do we do about this abuse? The truth is that an enormous amount of Medicaid money is spent on a minority of patients. As mentioned earlier, most Medicaid recipients do not abuse the system. How do we determine the good from the bad? I believe the answer is simple. Eliminate the word “free” from the Medicaid vocabulary. Your private health insurance is not free. Your Medicare insurance is not free. Neither of those two insurance plans is routinely abused.

The most expensive entry point into the healthcare system is the Emergency Department of any hospital. The amount of equipment, types of personnel and physician skill level make a hospital visit ten times as expensive as a physician office visit. Commercial health insurance and Medicare each has restrictions on the use of a hospital Emergency Department. Medicaid has no restrictions.

I have “a” plan for improvement. I will not try to claim it is “the” plan for improvement.

The following are the three main parts of my system improvement recommendations.

1.) I would keep free in the Medicaid vocabulary for all wellness and preventative services. These are the least used services currently because they are not perceived as needed. Anytime a Medicaid recipient has a health problem the system will try to fix it. So why use preventative services.

2.) I would require all new Medicaid recipients and dependents to get a free screening physical. This will include a drug test. While we cannot eliminate the use of illegal drugs, we could be better prepared to deal with the consequences of drug use.

3.) I would charge a co-pay for “every” hospital visit, except a true “urgent or emergent” visit to the Emergency Department. There are clinical descriptions for the terms urgent and emergent. Every Medicaid recipient has the opportunity to have a primary care doctor. Many do not use those doctors because they are seldom offered instant satisfaction when they feel a need for a doctor visit. Others do not use the doctors because the physician recommends changes to their lifestyle to improve their individual and family’s health status. This is considered an unacceptable intrusion on the lifestyle choices they are making.

Medicaid recipients often partake in other local, State of Ohio and Federal programs. A personal recommendation to really tighten up all the programs is to link Medicaid free services to continued receipt of other funds and services. If a mother or father does not get minor children for routine inoculations in a timely basis, cut off all other funds and services until the children are up to date with health and wellness services.

All Medicaid recipients and dependents should receive a routine physical and drug test twice a year. If the drug test is failed cut off funds from the offender and find ways to provide for any minor children. The State of Florida recently passed legislation requiring a drug test for all individuals applying for welfare services, including Medicaid. The potential welfare recipient must pay for the test. If they pass the test, they are reimbursed for the cost of the test. Florida is taking a step in the right direction.

I had someone offer an interesting analogy for Medicaid. It is like giving every Medicaid recipient a brand new Rolls Royce. When you give them the car, you tell them that this is the finest car in the world. It needs to run on premium gasoline and should be tuned up every 10,000 miles. If you bring it by the dealership they will perform all of the maintenance for free and fill your gas tank with premium fuel without charge. The person is also told that if they too are busy, they do not need to use premium fuel or ever get the recommended free services. This is because if the car doesn’t run well or they burn up the engine the dealer will replace everything on the car at no cost to them.

The Federal government plan is to reduce what they pay for both Medicare and Medicaid. The claim is fraud, abuse and inefficiencies in the health care system are causing the cost increases. It does not eliminate the problem and will not eliminate the ever increasing cost to all of us. FREE is the problem. Let’s get some economic responsibility built into the best health insurance plan on Earth.

Incidentally, Obamacare is expected to add 500,000, or more, Ohioans to the Medicaid rolls. Obamacare has no provision for additional doctors to care for the new patients or funds to pay for these new people. Enough is enough.

Wayne Deschambeau is the President/CEO of Wayne HealthCare and can be reached at wayne.d@waynehealthcare.org. Viewpoints expressed in these opinion pieces are the work of the author. The Daily Advocate does not endorse these viewpoints or the independent activities of the author.