Fomenting a Medicaid Revolution

Tommy Thompson, the former governor of Wisconsin and former U.S. Secretary of Health and Human Services, is touting a four-part Medicaid makeover. The program, ...
September 22, 2006

Thompson Tommy Thompson, the former governor of Wisconsin and former U.S. Secretary of Health and Human Services, is touting a four-part Medicaid makeover. The program, he says, "is broken" and one of his four fixes is to move long term care from Medicaid (a shared state-federal program) to Medicare (a program funded solely by the feds).

It would be hard to come up with a governor in office, formerly in that office or someone running for that office who wouldn't love to see that happen: give up the multi-billion-dollar burden of long term care for the elderly and let the fed budget take it on instead. And it's equally hard to think of a U.S. Representative who'd want to see the federal government shoulder those costs alone. So what's Thompson's strategy for moving LTC from column A to column B?

In a recent interview, Thompson, who is currently with Deloitte Touche consultants, saw the road to welfare reform as the blueprint for Medicaid change. To get the feds to take over LTC, Thompson admits, is a difficult sell, "but we can make it much more acceptable with innovative programs."

More from the exclusive interview with Thomspson after the jump.

Several years before the federal government passed welfare reform legislation, Thompson as governor of Wisconsin began asking the feds for waivers to experiment with AFDC reforms. "When I started welfare reform in Wisconsin, every governor said I was crazy -- how can you take on AFDC, it's a sacred program. Everyone knew it had failed but no one wanted to take it on." Through waivers, though, Thompson showed how Wisconsin could improve the program and much of that was part of the new approach to welfare. The same holds true for Medicaid reform. "I am confident," he says, "that if governors started some pilot programs, we could show the way and develop a lot of support at the federal level."

So what's he recommending to show the way on long term care? He starts off with a tax credit "for the person taking care of mom or dad so mom or dad don't have to go into a nursing home." He'd also like to see other programs that help the elderly stay at home longer. "Give them the opportunity to purchase things outright so that individual Medicaid recipients and dual eligibles could buy the services and things they need. I'm looking at something more expansive than a pilot program, something to use as a basis for getting the federal government to buy into this."

In His Own Words: More from Tommy Thompson Interview--

I envision a time when, if states took over Medicaid, they would be able to develop a program whereby the governor from, say, the state of Wyoming would set up program in which he or she would be able to get all children vaccinated and go to the National Governors Association conference as well as the New York Times and Governing Magazine and brag about having the healthiest children. The same thing would go for, say, the governor of Missouri to come in and say, 'I've got a program where all moms below poverty level or $30,000 a year have to have a mammogram so I have the healthiest moms.' States can unleash the power of innovation and opportunities.

We need to use more health IT. An Institute of Medicine report found that 98,000 people died from medical mistakes. Half of those were caused by doctors and health clinics giving the wrong medicine to the wrong person in the wrong amount at the wrong time. We can reduce those deaths and eliminate them by e-prescribing. That would be a tremendous step forward. But most doctors don't do it. Under Medicaid, we could demand that any doctor that takes Medicaid--or Medicare--patients has got to e-prescribe. Set the bar higher and that would get you the opportunity for improving health care considerably.

Second, on electronic medical records, we could require under Medicaid and Medicare that everyone has an electronic record in the next 24 months. We can use the power of Medicaid and Medicare to transform health care. A state could try that with electronic medical records, and once it's done, other states and goverment leaders would look to it and try to copy it.

States like to have bragging rights. Look at what the state of Washington is doing with e-prescribing. It requires doctors to e-prescribe. And Massachusetts' program for the uninsured--everyone will have coverage now. That's also opening up competition and encouragement for other governors during the election cycle to talk about innovative ideas to bring forward to cover everyone.

I'll bet you that in the next legislative session -- within the next 12 months -- there will be 20 to 25 states with uninsured programs similar but slightly different than Massachusetts' and e-prescribing cropping up in 25 states. Things mushroom and bubble up to the federal government. Just like welfare reform. It took eight years for the feds to get into the act on welfare. Same thing will happen with Medicaid. Mark my words. I predict that 20 to 25 states will act within 12 months and within six years the federal government will be adopting what states are trying with waivers.