>
>>Date: Thu, 6 Mar 2003 18:31:29 -0500
>>From: Justice For All Moderator <[log in to unmask]>
>>To: [log in to unmask]
>>Subject: Medicaid in Jeopardy
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>>"Medicaid in Jeopardy"
>>
>>The following op-ed from Today's New York Times paints a
>>sobering picture about the potential dangers of the Bush
>>Administration's approach to Medicaid policy.  Congress and
>>the Clinton Administration worked together in the 1990s to
>>expand access to Medicaid, including for people with
>>disabilities who want to work and retain access to
>>Medicaid.  Now most states are in major budget crises and
>>many may be forced to cut access to Medicaid and reduce
>>Medicaid services in an effort to balance budgets.  The
>>Bush Administration, however, has resisted states' requests
>>for more federal support and instead appears more eager to
>>have Medicaid recipients seek private insurance.  While
>>obtaining private health insurance is cost-prohibitive for
>>many low-income individuals, it is especially difficult for
>>many people with disabilities who can face higher premiums.
>>Sustaining Medicaid is therefore crucial.  Moreover, the
>>goal of expanding access to Medicaid home- and community-
>>based services will be significantly undermined if states
>>can't even manage to fund current services.
>>
>>Jonathan Young
>>JFA Editor, AAPD
>>
>>=================================
>>
>>How Medicaid Was Set Adrift
>>
>>March 6, 2003
>>By JONATHAN COHN
>>The New York Times
>>
>>ANN ARBOR, Mich. - As President Bush kicked off his plan to
>>reform Medicare and the country's malpractice laws on
>>Tuesday, he didn't mention one of the most important policy
>>achievements of recent years: the expanded role of
>>Medicaid, which provides health care to low-income
>>Americans. But then, Medicaid is the success story that
>>almost nobody has paid attention to.
>>
>>Since the late 1980's, the proportion of Americans
>>receiving health insurance through their jobs has declined.
>>So during the late 1990's, the Clinton administration and
>>the states tapped their unexpected budget surpluses to make
>>Medicaid more widely available. They eased eligibility
>>requirements and got more aggressive about enrolling
>>people. As a result, 47 million people receive Medicaid
>>today, up from 40 million in 1998. Despite the waste and
>>abuse common to public and private health programs,
>>Medicaid has done a remarkably good job of serving a
>>low-income, poorly educated and multicultural population.
>>And without it, the high number of Americans without health
>>coverage today - some 42 million - would likely be a few
>>million higher.
>>
>>Unfortunately, that progress is now in jeopardy. With more
>>people out of work and private health insurance
>>increasingly unaffordable, there is a new wave of
>>struggling Americans looking to the government for help.
>>But the states, suddenly beset by budget deficits, are in
>>no position to provide it this time around. That's why the
>>country's governors went to Washington last week, literally
>>begging for temporary assistance, and why even normally
>>spendthrift Republicans in Congress seemed inclined to
>>support them.
>>
>>President Bush, however, has proposed something quite
>>different. Instead of helping states bolster Medicaid, he
>>wants to help them cut it. It's an odd way to preserve such
>>an important piece of public policy; then again, preserving
>>Medicaid may not be the precise goal Mr. Bush has in mind.
>>
>>When he first unveiled his Medicaid plan in January, he
>>boasted of its generosity, since it included more than $3
>>billion in new money for the states next year - part of an
>>additional $13 billion they would receive over the next
>>seven years. But given that the states are looking at about
>>$70 billion in overall deficits next year, that's hardly
>>enough to keep Medicaid going as is, let alone allow it to
>>accommodate additional needs while unemployment remains
>>high. (By comparison, a bipartisan bill would give the
>>states an immediate infusion of $20 billion, half of it
>>explicitly dedicated to Medicaid.)
>>
>>And when you read the fine print in the president's plan,
>>you discover the real dangers. Like a bank making a loan -
>>or, as critics have put it, like a loan shark exploiting a
>>client's vulnerability - the president would require the
>>states to pay back all of the $13 billion in the three
>>years that follow the initial seven. In addition, states
>>accepting the upfront money would have to sign off on a
>>major shift in the program's overall financing scheme:
>>
>>Washington would stop providing the bulk of its Medicaid
>>financing as matching funds, which rise as states enroll
>>more people. Instead, it would provide a fixed sum each
>>year, based on a formula that could easily underestimate
>>the true need for services.
>>
>>When asked about these reductions, Bush administration
>>officials have insisted they won't really hurt - that
>>through "innovation" the states would learn to do more with
>>less money. But a look at the regulatory changes in the
>>plan suggests just what sort of innovations they have in
>>mind. The Bush scheme would make it easier for the states
>>to cut services like prescription drug coverage,
>>prosthetics, eyeglasses and most nursing-home care.
>>
>>Although this may not sound like "compassionate
>>conservatism," it's entirely consistent with the
>>administration's broader approach to health policy.
>>President Bush has repeatedly made it clear he wants the
>>government out of the business of providing health
>>insurance - if the poor find themselves uninsured, he'd
>>prefer the government give them tax credits to buy private
>>policies.
>>
>>But while that private-sector approach may sound appealing
>>as part of a stump speech, in the real world it doesn't
>>work. Mr. Bush's tax credit proposal, for example, would
>>give individuals up to $1,000 annually to buy a policy -
>>which would cover only a few months of decent insurance in
>>most parts of the country. In addition, Mr. Bush has shown
>>no willingness to enact the kinds of regulations necessary
>>to guarantee that insurance is available to the people who
>>need it most, including those with pre-existing conditions
>>like chronic diabetes.
>>
>>It was precisely because the poor couldn't afford health
>>insurance that the federal government created Medicaid in
>>1965. It's also the reason that, in trying times like
>>these, previous administrations have dipped into the
>>treasury to keep the program going. Maybe President Bush
>>just doesn't understand this history. Or, sadly, maybe he's
>>intent on reversing its course. Either way, his plan would
>>force many states to cut back a vital and effective health
>>insurance program at the very moment their citizens need it
>>most.
>>
>>Jonathan Cohn, senior editor at The New Republic, is a
>>media fellow with the Kaiser Family Foundation.
>>
>>http://www.nytimes.com/2003/03/06/opinion/06COHN.html?ex=10
>>47991742&ei=1&en=65d3cf0cc189069d
>>
>>[Note: above link is broken into two lines.]
>>
>>Copyright 2002 The New York Times Company
>>
>># # #
>>
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