Medicaid spending in Mass. has nearly quadrupled in the past 20 years. It needs reform.

Boston Globe

14 hours ago

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Medicaid was
The cost of this is staggering. The budget for the state's Medicaid program, called MassHealth, has
to over
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But this explosion in the cost of Medicaid begs the question: Has all this spending led to better health outcomes? Surprisingly,
Despite these findings, even modest Medicaid reform in Republican proposals before Congress — like encouraging community engagement through volunteering or work, preventing duplicate payments to insurers, and closing state-level
However, it should be noted that the current proposals in Washington — which the House passed last week and are now in the Republican-controlled Senate — will result in more Medicaid spending over 10 years, not less. The bill merely slows the rate of growth. Only in Washington, D.C., is more spending decried as a cut. The fundamental issue remains: Are we prioritizing the right goals?
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The evidence on the power of connection is
.
Past state-level experiments with work engagement in programs like food stamps and welfare cash assistance offer a promising road map. A
Medicaid reform could similarly refocus state efforts on connecting enrollees with community engagement rather than solely maximizing federal funding. Encouragingly, these past reforms also saw a halving of the time individuals needed to stay on public assistance.
Shouldn't we celebrate if someone like J.D. could earn enough to transition to employer-based or ACA coverage? Sadly, too often, critics characterize
any transition off Medicaid as
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While Medicaid reform often faces bipartisan heartburn, paradoxically there's longtime bipartisan agreement that major entitlement programs are growing unsustainably. If we can't at least slow the rate of growth, in part by delivering better outcomes, then our fiscal house of cards may fall, which hurts the most vulnerable.
Our leaders must shift the debate from simply protecting the flow of federal dollars to ensuring that every Medicaid dollar genuinely improves patient health. Current inertia seems more about preserving the status quo than addressing the health impact on individuals like J.D. Meanwhile, our communities suffer as we miss out on J.D.'s contributions to society.
The federal proposals provide a crucial moment to discuss opening doors of opportunity rather than defending a system that requires poverty for coverage. It's time to move beyond simply paying insurance companies for a card in J.D.'s pocket and focus on reforms that foster human thriving.