Washington, D.C., September 1, 2005 - “Medicaid remains a ‘best buy’ program for the health of the American people. As Congress deliberates the merits of the recommendations from the Medicaid Commission, we hope they will consider the significant benefits of this important program. We are concerned that the recommendation for higher co-payments will jeopardize the health of beneficiaries who generally have less income. Even nominal co-payments are a hardship for many beneficiaries, and co-payments beyond nominal amounts, which the Commission calls for, may be a financial barrier to care and have a devastating health impact.
“Poor Medicaid beneficiaries already spend a larger share of their incomes on out-of-pocket medical expenses than do middle-class people with private health insurance, and the addition of new, increased co-payments in state Medicaid programs may deter people from seeking necessary medical services, increase reliance on emergency health services or lead many to become uninsured, as recently seen in Oregon. A person whose health depends on a non-preferred drug may not get his prescription filled if he cannot afford the higher price. Low-income individuals who are affected by chronic health conditions and HIV/AIDS are particularly at risk for being overwhelmed by unaffordable medication costs. Outcomes from this option may become even more troubling with the possibility that children, pregnant women and residents in nursing homes—who are currently exempt from all cost sharing as mandated by federal law—may also be forced to pay higher co-payments. We must ensure that Americans have access to the medication to which they are entitled. We urge members of Congress to not follow this recommendation of the Commission, and in general not institute new or increase existing co-payments for covered services in the Medicaid program.
“We agree with the Commission that the use of Average Wholesale Price (AWP) has led to inflated pricing of drugs. State Medicaid programs, which serve the poorest Americans, currently pay more than private health insurers, the Veterans Administration and Medicare for prescription drugs. This needs to change.
“Assuring access to affordable prescription drugs for Medicaid beneficiaries is just one of the many ways the program improves individual and population health status and outcomes. In general, Medicaid ensures the survival of individuals by giving them access to primary and preventive health services that they could not obtain otherwise. This does not solely impact the health of program enrollees, but the population as a whole—people with whom they interact every day.”
In advance of today’s report from the Medicaid Commission, APHA released a white paper on Tuesday that outlines four priorities policy-makers should protect when considering Medicaid reform:
- ensuring access to preventive services;
- guaranteeing treatment for children with conditions and illnesses detected during screenings;
- prohibiting cost sharing for receipt of covered services; and
- assuring access to affordable prescription drugs.
The full text of the white paper is available here. The executive summary can be found here.