Amanda Glassman: Budget Crisis Could Lead to Health Care Rationing


As more and more states go deeper in the red, the possibility of "health care rationing" becomes more and more probable. Arizona recently decided to halt Medicaid reimbursements for organ transplants, for example.

I've talked to some of my contacts in DC and they say health care rationing could be the next big thing in today's tumultuous fiscal reality. I decided to speak with Amanda Glassman, Director of Global Health at the Center for Global Development, to find out more about about this phenomenon.

LL: As we have more states trying to fix their financial woes, are we going to see more of this given the health care rationing by States?

AG: I think yes—especially because if you are talking about deficit reduction that means it will affect health care funding through Medicaid and Medicare. And that means decisions will have to be made in states about what will be financed with public resources and what will not. Unless you have a better process to go through, you are going to see more of these adhoc decisions that really are legally venerable. Because anyone of those families could take the state to court if they are denied.

I think ultimately it will be more expensive for states to engage in this adhoc behavior they are currently engaged in. If budgets continue to decline health rationing will be more likely.

LL: Can Obamacare stop this rationing?

AG: No, this is outside of the jurisdiction. This type of health care rationing has always existed. The States could always decide on what Medicaid covered. The CMS (the Centers for Medicare and Medicaid Services) decides on Medicare.

LL: Are we going to see further health care rationing under Obamacare?

AG: We have health care rationing right now that is extensive. If you have a private insurer you know there are some things that are covered and other things that are not. What happens is you pay more out of pocket when things are not covered. Or they just won't reimburse other things. That's how insurers ration now.

I think the main impact of the ACA is to extend access to insurance. And if you are going to extend these benefits to the uninsured there has to be a definition of what exactly is going to be offered.

For example, Medicaid has a set of benefits that are provided but its not an endless set. I think its about the same amount of rationing but it will be in more ethical in a sense, because right now health care rationing is based on the ability to pay for those people who are insured. So, now there will be more people insured and they will have access to more benefits and most of their expenses will be covered.

LL: So is Obamacare a positive for health care rationing?

AG: It's almost neutral because ACA looks at effectiveness. It's not based on cost. It is positive. To finally have a reform in place that tries to provide insurance for the majority of the population. That's a huge step forward.


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A Senior Talent Producer at CNBC, and author of "Thriving in the New Economy:Lessons from Today's Top Business Minds."