On April 20, while addressing an audience of internists at the American College of Physicians’ annual scientific meeting, Kavita Patel, MD, emphasized that Medicaid is “breaking the backs of state budgets.” States such as Pennsylvania and Ohio are unilaterally cutting subsidies for education and other issues to help pay for rising healthcare costs, she said.
Patel, a practicing primary care internist at Johns Hopkins Medicine, is also managing director for clinical transformation and delivery at The Brookings Institute’s Engelberg Center for Health Care Reform in Washington. She previously served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement.
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“This is affecting those of you who have kids in these states and are paying college tuition,” Patel said. “As you see your pocketbooks empty more and more to subsidize these issues, it starts to generate antipathy and antagonism against what is the standard. And, right now, Obamacare is considered the standard.”
In an interview with PhysBizTech following her presentation, Patel previewed the political forces likely to be in play in Pennsylvania after the state’s April 24 primary elections. Even though Republican front-runner Mitt Romney is expected to take most of Pennsylvania’s proportionally allocated delegates, both parties will have to pay close attention to their messaging regarding healthcare costs as they move forward. Pennsylvania, Ohio and Florida are the most populous “beige states” – neither leaning red nor blue – that could very well determine the outcome of the presidential election in November.
“Talking about these issues is going to be really complex in the beige states,” Patel noted during her discussion. By 2020, according to government estimates, more people will be enrolled in Medicaid than Medicare. “So the expansion of Medicaid becomes all the more important,” she continued. “But the question becomes, How will you pay for all that? Everyone is going to ask, Where will you get the money?”
On one hand, candidates will have to figure out how to contain costs in the system and where they stand on moving lives into managed care. At the same time, they’ll have to formulate plans for cost-containment so that budgets will continue to fund state universities and offer subsidized college tuition.
Not coincidentally, on April 23 while campaigning in Pennsylvania, Romney backed President Obama’s proposal to extend low-interest rates for student loans. The rates are scheduled to double on July 1, from 3.4 percent to 6.8 percent, on federal loans for low- and middle-income families, according to an Associated Press report.
On a broader scale, such policy agreement won’t be common when Romney and Obama return to beige states such as Pennsylvania as the campaign enters the post-primary season.
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The Democratic messaging will remind voters that the president’s administration started this process and “we’re doing something in Pennsylvania to carry out health reform.” Republicans will counter with, “all this is probably not working” and “health costs – aside from Medicare alone – are taking away from resources at the state level,” Patel predicted.
So the stage has been set for a climactic post-primary debate between presidential contenders. Probabilities point to re-election of the president – but without him having congressional control. Nonetheless, there’s no such thing as absolute certainty in presidential politics.
As Patel cautioned the physician audience last week, “I worked on health reform in the Senate and the White House. We did a poor job on messaging around health reform. We clearly didn’t communicate outside of our own little silos and settings, and we’re seeing the result of that because of the delay in implementation in parts of the Affordable Care Act.”
For more of our primaries coverage, visit Political Malpractice: Healthcare in the 2012 Election.
