Under a Medicaid waiver approved Wednesday by the federal Centers for Medicaid and Medicare Services, Medicaid beneficiaries will be given "vouchers" to go out and buy private health insurance. HMOs or other insurance providers--not the state--will set forth the scope of the benefits available under the plan.
While everyone is focusing on this aspect of the Bush plan--the private rather than the public sector determining benefits--there's another tricky issue here. Bush will be asking Medicaid recipients, beginning with non-elderly adults, to slog through the fine print of insurance plans and figure out which best fits their health needs and has a maximum benefit that won't leave them bereft of health care.
It's a risky business and a lot to ask. Most of us, according to a Commonwealth Fund study prefer to have our employers select health plans for us--and this aversion to choice is within a population that has a good deal of confidence in interpreting written material. Taking ownership of health services is fine in principle, but not necessarily when it comes to parsing the complicated details of half a dozen insurance plans.
