The GOP dream of killing medicare is coming true !
States Cut Medicaid Coverage Further
http://www.truthout.org/122608E
States from Rhode Island to California are being forced to curtail
Medicaid, the government health insurance program for the poor, as
they struggle to cope with the deteriorating economy.
With revenue falling at the same time that more people are losing
their jobs and private health coverage, states already have pared
their programs and many are looking at deeper cuts for the coming
year. Already, 19 states - including Maryland and Virginia - and the
District of Columbia have lowered payments to hospitals and nursing
homes, eliminated coverage for some treatments, and forced some
recipients out of the insurance program completely.
Many are halting payments for health-care services no
"It's not a pretty list at all," said Michael Hales, Medicaid
director in Utah.
Medicaid, a central piece of the Great Society safety net created
in the 1960s, is the nation's largest source of government health
insurance. It covered 50 million Americans last year. The program is
a
shared responsibility of the federal government and the states, with
federal money paying an average of 57 percent of the bills and states
providing the rest.
Federal health officials set minimum rules about who can enroll
and what care must be covered, but states are free to add to the
basics. Those optional patients and services are what many states are
rethinking now.
With the program the largest or second-largest expense in every
state's budget, governors and state legislators have been pleading
with Congress and the incoming Obama administration for help. The
Democrats, who hold majorities in the House and the Senate, are
sounding sympathetic for now. They are considering close to $100
billion to increase the share of Medicaid's costs that the federal
government would pay during the next two years.
President-elect Barack Obama also is open to extra help for
Medicaid as part of a broad strategy to spur the economy. "We are
considering a number of proposals . . . including helping states meet
Medicaid needs; reducing health-care costs; rebuilding our crumbling
roads, bridges and schools; and ensuring that more families can stay
in their homes," said Nick Shapiro, an Obama transition spokesman.
According to a Washington source who is in close contact with
lawmakers, some in Congress also are beginning to entertain the idea
of allowing unemployed people who have lost health benefits to sign
up
for Medicaid, with federal money paying the entire bill.
In the meantime, uncertainty over how much help may come, and
when
it might arrive, is prompting many states to make the biggest
reductions to their Medicaid programs in years - and in some cases,
ever.
Diane Rowland, executive director of the Kaiser Commission on
Medicaid and the Uninsured, said the pressure on Medicaid programs is
particularly acute because the economy has deteriorated so soon after
a milder recession early in the decade. States already "have taken
the
cuts that were making the program more efficient. . . . Now they are
making ... cuts into the core," she said.
Nineteen states and the District have cut Medicaid for the
current
fiscal year, according to a survey this month by Families USA, a
liberal consumer health lobby. All but one, plus six other states,
are
drafting deeper reductions for the coming fiscal year that they hope
to avoid. Florida's Medicaid officials have just handed the governor
and legislature a blueprint for a 10 percent reduction; it would
eliminate coverage for 7,800 18- and 19-year-olds and 6,800 pregnant
women.
Among the states with the gravest financial problems - and
pressures on Medicaid - is California. In July, Medi-Cal, as the
program there is known, slashed by 10 percent the rates it pays
hospitals, nursing homes, speech pathologists and other providers of
health care. It tried to lower payments to doctors and dentists, too,
but they have sued to block the decreases.
Gov. Arnold Schwarzenegger (R) has asked the state legislature to
approve other cuts, including an end to dental care for adults, about
1 million of whom use it now, and a sharp reduction in care for
recent
immigrants.
At two hospitals run by NorthBay Healthcare, midway between San
Francisco and Sacramento, about one patient in five is on Medi-Cal.
The rate cuts translate into a $4 million loss this year. In
September, the health system closed a rehabilitation program for
children that provided physical therapy, speech therapy and other
help
to about 300 young patients at a time - with 100 more usually on the
waiting list.
"It was heart-wrenching to have to go out an
The strain has spread through the Washington area. The District's
Medicaid rolls have risen by 5,000 in the past year to nearly
150,000.
To cope, the District made $20 million worth of changes to the
program
and a separate fund for people who are uninsured, including
postponing
an increase in payments to primary-care doctors.
In Maryland, Medicaid enrollment has jumped by 8 percent in the
past year, and the state has pared $82 million from the program for
this year, reducing planned increases in payments to nursing homes,
managed-care organizations, private nurses and home health aides.
With
a larger state deficit forecast for next year, Gov. Martin O'Malley
(D) is expected to propose deeper cuts in his budget next month,
probably including a lengthy delay of the state's biggest Medicaid
expansion in years: a planned extension of coverage to 100,000
parents
and other adults.
In October, Virginia eliminated a small fund for indigent
patients. For the coming year, Gov. Timothy M. Kaine (D) has just
proposed $245 million in cuts from the nearly $3.3 billion that the
commonwealth devotes to Medicaid, including reduced payments to
hospitals and new limits on home health care.
Rhode Island's approach has been the most far-reaching to date.
This week, it announced an agreement with U.S. health officials that
would, if the state legislature consents, change the entire financial
basis of the program. The state would forfeit its Medicaid
entitlement
and accept a total of $12 billion in federal money over the next five
years. In exchange, Rhode Island would win uncommon freedom from
federal rules, allowing it to enroll all its Medicaid patients in
managed care, cover less treatment and expand care for elderly
patients at home, instead of in more-expensive nursing homes.
In South Carolina, Medicaid officials last week announced the
third round of cuts since August. They are "real unpleasant stuff,"
said Jeff Stensland, spokesman for the state's Department of Health
and Human Services. The program will stop paying for most dental care
for adults, eliminate nutritional supplements, cut home-delivered
meals from 14 a week to seven, curtail mental health counseling, stop
building wheelchair ramps and pay for fewer breast and cervical
cancer
screenings.
Edna McClain, founder of Hospice Care of Tri-County in Columbia,
S.C., helped coax state health officials to expand Medicaid to cover
nursing care and other support for dying patients in the mid-1990s.
She was stunned this month when an e-mail arrived from South
Carolina's Department of Health and Human Services informing her that
as of Jan. 1, Medicaid no longer would pay for new hospice patients.
And after March 31, it would stop covering most people on Medicaid
already in hospice care.
With a $500,000 hole in her budget, she worries about how to care
for low-income hospice patients, including a 47-year-old man whose
weakened body is dangerously retaining fluid as he awaits a liver
transplant.
The day after she received notice from the state, McClain
composed
a letter and fired it off to 107 state legislators. "They can at
least
hear from me," she said. But she knows, she said, her protest is too
late to make a difference.
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