MARC SIEGEL: No disincentive for overuse. No co-pays. No deductibles. In states that have the Medicaid expansion, emergency room visits are up by nine percent. Now, hospitals like that because patients that used to be uninsured now have their Medicaid card, but they're flocking into the ERs to get services they don't often need. Did you know, Brian, that 15 percent of Medicaid patients are prescribed an opioid every year? Now, that's the doctor's fault for overprescribing, but Medicaid allows doctors to overprescribe. And that's one of the secret stories that we're breaking right now, is that the opioid epidemic is tied to Medicaid as an enabler. Doctors are the problem. Medicaid is enabling it.
BRIAN KILMEADE (CO-HOST): So, Dr. Siegel, if I've put you in charge of fixing it, where do we start?
SIEGEL: Well, I'd scale it back to basic services. What does a person really need? Look, there's a lot of disabled patients, a lot of children that are on Medicaid. There's people that -- really poor people really need Medicaid. But do they need a wheelchair every two years? I don't think so. I want to scale back the excess. And then, as Medicaid director Seema Verma has said quite smartly, let's have premium buy-ins in the Medicaid expansion states for services beyond what you need. How about a bridge-to-jobs program?
KILMEADE: What does that mean? I'm sorry, can you tell me, what does that mean? Premium buy-ins?
SIEGEL: It means if you want more than the basic services.
KILMEADE: OK.
SIEGEL: And have you some income -- OK? -- we're talking about the Medicaid expansion states. Then you can pay a premium to get more than you would just freely be given. And, also, we need bridge-to-jobs programs in the Medicaid expansion states because people that don't have jobs, Brian, get their Medicaid card, and they say, “I don't want to give it up. I don't want to give up that Medicaid because I can't afford to take that job. I won't get as good of health care.”
