Las Vegas Sun

November 29, 2023

Where I Stand — Kenny Guinn: Making Medicaid work

Editor's note: In August the Where I Stand column is turned over to guest writers. Today's columnist is Kenny Guinn, the governor of Nevada.


August 6-7, 2005

Due to the Medicaid crisis that our country has faced during the early years of the 21st century, some Americans have faced a difficult choice, one that is almost incomprehensible for the world's most prosperous and powerful nation: Do some of our citizens not purchase food ... so they can afford to buy medicine?

I believe our country can do better in facing the challenge of Medicaid, which is celebrating its 40th anniversary this year. I believe Americans shouldn't have to choose food over medicine, or vice versa. And I believe that in Nevada, we are taking every step possible to ensure that this never happens.

In 1965, when the Social Security Act was amended to create health insurance for the poor of all ages, the hope was that millions of Americans whose limited income prevented them from full health care coverage would finally receive the health care they needed.

The program has been wildly successful: Medicaid serves more than 50 million Americans and, in addition to providing health care for the poor, also serves an important role for our elderly as well as our disabled populations.

Since 2000, however, Medicaid's caseload has grown 40 percent and states are staggering beneath the burden of supplying funding for what the National Association of State Budget Officers has described as "the fastest growing category of state spending" for all states.

Medicaid's growth has created a difficult balancing act for state governments, which must strive to maintain or increase health care services while finding creative ways to control spending -- all the while adhering to federal mandates associated with the program. In Nevada, Medicaid represents about 15 percent of state funding and trails only public schools and higher education funding.

The program's current two-year cost is more than $2.5 billion, with the federal government supplying about $1.4 billion. As one might expect with the fastest-growing state in the country, we also have a fast-rising caseload figure: the average monthly caseload of 177,000 in 2005 will top 188,000 by 2006 and grow to 197,000 in 2007.

We must understand that as our caseload increases, we must strengthen and sustain our Medicaid offerings. Drastic cuts in the program are not the answer. Consider the sobering news last summer from Mississippi, where cuts in Medicaid eligibility promised to impact more than 60,000 senior and disabled citizens.

In Nevada, we can do better. We are working to constantly strengthen and protect our current system, while finding ways to improve its efficiency. We have planned carefully and shown sound fiscal stewardship through Nevada's Department of Human Resources and the Division of Health Care Financing and Policy. In order to preserve Medicaid, we must make some critical changes.

We have undertaken a number of innovative initiatives and programs, which have been important first steps in accomplishing the goals that I believe are critical to the future of the program. Medicaid's quality must be enhanced and costs must be contained; employer-based private health care must be strengthened; and the growth of Medicaid's long-term care must be slowed.

The state's initiatives to accomplish these goals include programs such as using home- and community-based services to cut costs and allow greater autonomy for many of our citizens; improved management of prescription drugs, including rebates and discounts negotiated through a pool of seven state Medicaid programs; use of assessed fees on in-state nursing facilities to generate savings and improve services and direct health care. These efforts alone have helped generate more than $49 million in revenue to improve our Medicaid offerings.

Given these efforts, I am optimistic about Medicaid's future in Nevada. During a National Governors Association meeting in February in Washington, D.C., I hosted a roundtable discussion regarding Medicaid with a group of Republican governors and Secretary of Health and Human Services Michael Leavitt.

Secretary Leavitt, a former governor of Utah, spoke with candor that day, encouraging the states to find innovative programming and creative ways to ensure that Medicaid meets its mandates, and serves all who need the program. By continued use of cost-saving programs and federal subsidies, Nevada will continue to increase the financial solvency, patient services and administrative efficiency of our Medicaid system.