Reform Worked Until Rejected

A Medicaid reform experiment championed by Sen. Joe Manchin, D-W.Va., while he was governor was a dismal failure, West Virginians were informed this week.

There’s just one problem with that assessment: It isn’t true.

Some of the very same folks who had no use for Manchin’s Mountain Health Choices program while it was in progress are jumping for joy. Now, they have a university study to back them up. And everyone knows university studies are not to be questioned or criticized.

Medicaid provides health insurance for more than 330,000 low-income and disabled Mountain State residents. The program’s cost is enormous and growing by leaps and bounds.

While he was governor, Manchin heard of an idea that seemed as if it could both improve the health of Medicaid clients and reduce the program’s cost. It was implemented in West Virginia under the title Mountain Health Choices.

MHC was a simple concept: Medicaid clients were told they could enroll in it and receive better benefits than they had in the past. In exchange, they were required to sign personal responsibility pledges. In essence, the agreements bound MHC clients only to keep health care appointments, avoid using emergency rooms except for genuine emergencies, follow physicians’ orders and find family doctors. In other words, they weren’t required to do anything more than what most West Virginians already did.

Medicaid clients who didn’t sign up for MHC were limited to a basic menu of health care services. They didn’t lose any coverage, but they didn’t receive the enhanced MHC package, either.

From the word “go,” lots of people hated MHC. Why? Because, in effect, it discriminated between people willing to take responsibility for their own health and those who would not.

And, to be fair, there were severe failings in letting people know about the program and signing them up. As a result, only about 14 percent of Medicaid enrollees chose MHC during its brief lifespan from 2007-10.

MHC was scrapped in 2010 after a new federal rule in effect made it impossible to continue.

This week, MHC’s critics got what they viewed as a Christmas present, in the form of a report on the program from George Mason University’s Mercatus Center. The center is described as “dedicated to bridging the gap between academic research and public policy problems.”

MHC was supposed to reduce the number of emergency room visits for non-emergencies by Medicaid clients. But, according to the university study, the number of such visits by West Virginia Medicaid enrollees increased during the MHC period.

An early critic of MHC, House of Delegates Health and Human Resources Chairman Don Perdue, D-Wayne, insisted that proved “this program wound up costing us money, not saving us money.”

So MHC was a flop that should never have been tried, right?

Wrong. The university study indeed showed emergency room visits for non-emergencies by the entire Medicaid population increased from 2007-10. But read the fine print: Misuse of emergency rooms decreased by 5 percent among MHC enrollees.

In other words, MHC worked as advertised. Had the state been given more time to make Medicaid clients aware of the program and sign them up, misuse of emergency rooms might have decreased even more. Federal officials who write most of the rules for Medicaid, wouldn’t allow that.

Now, Washington is insisting that West Virginia dramatically expand the number of people on its Medicaid rolls. And federal control is going to be even tighter. There will be no more experiments with personal responsibility – just more government pressure to make people more reliant on government and less on ourselves.

So the university study, which really proves MHC worked, is being distorted in an attempt to claim just the opposite – and, not incidentally, to give reformers like Manchin a bad name. No wonder the nation is $16.4 trillion in debt.

Myer can be reached via e-mail at