What President Trump needs to do to solve the impending Medicaid crisis - Granite Grok

What President Trump needs to do to solve the impending Medicaid crisis


The fundamental duty of the United States Government is to protect its citizens and to responsibly manage the resources of the country. The first duty has been fairly well exercised. In regards to managing the country’s resources our politicians have failed miserably. The national debt now stands at approximately $23 trillion and the country is basically bankrupt. Over the next decade Medicaid costs probably will be the straw that breaks the nation’s fiscal back.

The estimate cost of Medicaid in 2026 is $1 trillion and is scheduled to continue to elevate with no end in sight. Right now it is around 600 billion/year.  This increase is not sustainable.

President Trump is the only one with the intestinal fortitude that will be required to fix this problem.

President Trump’s statement on Medicaid should be:

It is time for all aspects of healthcare including hospitals, physicians, support personnel and any other providers to make a commitment to the basic concept of paying their deb to the American society and providing healthcare for the unfortunate. There are only so many resources available to fulfill this commitment. These available resources must be considered “Payment in Full”.

How to do it:

1. Medicaid must be block granted. This means a set amount of money is sent to each state and the individual state governments decide how to allocate it. This is not a new concept and in the last Congress a viable proposal was made referred to as the Graham-Cassidy bill. In the past block granting Medicaid was frowned upon because governors of individual states could not see how it could be financially be viable.

The key to moving block grants forward is to have the Governors of each state link the physician’s licenses, all other healthcare facilities and all providers to taking Medicaid (including hospitals and dentists). This in effect takes care of the problem of State Budget of Medicaid. The Gov./State can set the bill at what they can pay. The non-profit hospitals (and all other providers) will have to deal with it. Please note that for profit hospitals provide the same service for 10-30% less. In other words there is plenty of leeway for the nonprofit hospitals to become more efficient and fulfill their stated goal of taking care of the sick. The rich healthcare communities will need to subsidize the poor ones. A plan can be devised that establishes statewide norms. Using these norms all healthcare communities will equally contribute to the poor. In addition most hospitals are nonprofit and enjoy a tax-free status. No longer will these hospitals that primarily cater to the affluent and turn massive profits, not pay their fair share. Basically the rich hospitals that do not take care of a large percentage of the poor will subsidize the hospitals that do.

Many physicians and other healthcare providers exclude the Medicaid population and make massive profits by leveraging their skills at private corporations such as surgical centers, convenient cares, infertility clinics, imaging centers and radiation centers. These loopholes need to be addressed and large amounts of revenue can be generated by allowing these types of entities to buyout of the Medicaid requirement.  The revenue generated by these buyouts would be substantial and dedicated to the Medicaid population.

Our nation’s future depends on the American healthcare system stepping up and accepting the resources that are available to pay for Medicaid. There is no question the healthcare community can absorb these patients and give them good health care. When the hospital administrators start to howl about how they can’t keep their doors open remember for-profit hospitals provide the exact same services for 15 to 25% less. In other words there are plenty of resources in the system to absorb these patients.


Dr Betti is a practicing New Hampshire physician. He helped manage a private urology practice for 20 years. Former Vice Chairman of the Lahey Health Urology Department for practice management. Member of the American Urological Association Coding and Reimbursement committee. Member of the American Urologic Association National insurance and Advisory Workgroup. Member of the New England Medicare advisory committee.

All views are his alone and in no way reflect any other person or organization.

He can be reached at CRANLK@comcast.net