US: Bush administration targets medical care for the poor

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Fri, 31 Dec 2004 08:44:42 -0800

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US: Bush administration targets medical care for the poor

By Jamie Chapman

31 December 2004

 

The federal government has dispatched auditors to state capitals around

the country in an effort to rein in the cost of Medicaid, the program

designed to provide medical coverage for the poor. The program also

pays

for about 70 percent of the nation's nursing home patients.

 

The cost of the program is shared between the states and the federal

government. The purpose of the audits is to challenge reimbursements

put

in by the states for the federal share of treatments.

 

Such an attempt to shift a larger share of Medicaid costs onto the

states would wreak havoc on those denied Medicaid services as a result.

Budgets for state services are still reeling from the impact of the

recession and the collapse of the stock market bubble.

 

Enacted in 1965, Medicaid established the right of those with low

incomes to obtain basic medical care, including hospital care

(inpatient

and outpatient), physician services and nursing home care. It was among

the last social reforms carried out at the end of the postwar boom,

along with Medicare, a government program to provide health care to the

elderly.

 

The cost of Medicaid has skyrocketed, increasing 63 percent in the last

five years. The total tab is expected to exceed $300 billion this year,

of which the federal budget is due to contribute $190 billion.

 

The high cost is a direct product of the corporate restructuring that

has left more and more workers to be forced into low-wage jobs, or

without jobs altogether. These workers now meet the low-income

requirements to sign up for Medicaid. Today, the program encompasses

more than 50 million beneficiaries, while another 45 million workers

are

left without health insurance at all, not even Medicaid.

 

Bush's point man in the attack on Medicaid spending is Michael Leavitt,

designated to take over the Department of Health and Human Services.

Before taking over a year ago as head of the Environmental Protection

Agency, he earned his spurs as governor of Utah. The Medicaid " reform "

he enacted there involved various restrictions of services to the poor,

such as limiting the numbers of prescriptions allowed to recipients.

 

He is touted for setting up a program for formerly uninsured workers at

no cost to the federal government. What is not widely publicized is

that

the cost of the program was financed by cutbacks in benefits for other

Medicaid participants. The new program limited recipients to only four

prescriptions a month. Hospital care and mental health benefits were

excluded entirely.

 

One unnamed Medicare official was quoted in the New York Times as

saying

that these are the types of changes that are in the offing. " That's the

direction the administration wants to go, " said the official.

 

Besides the benefits cuts imposed under Leavitt, officials are

considering allowing states to impose higher co-payments and

restricting

eligibility without obtaining federal waivers, as would now be

required.

 

Speaking of Bush's plan to shift billions of Medicaid costs away from

the federal government and onto the states, one governor, Republican

Mike Huckabee of Arkansas, described it in the following terms: " To

balance the federal budget off the backs of the poorest people in the

country is simply unacceptable. You don't pull the feeding tubes from

people. You don't pull the wheelchair out from under the child with

muscular dystrophy. "

 

Medicaid currently insures a quarter of the nation's children, close to

20 percent of whom live below the poverty level, by conservative

estimates. Huckabee's doomsday scenarios are exactly what the Bush

administration is contemplating.

 

The prospects prompted the National Governors' Association to issue a

letter to federal officials urging them not to cut state Medicaid

financing in an effort to cut the federal deficit. Medicaid already

represents 22 percent of states' budgets. It is greater than the total

education expenditure on grades kindergarten through 12.

 

No doubt, politics played a part in the issuing of the governors'

letter. Nineteen Republican governors are up for re-election in the

next

two years—including Arnold Schwarzenegger in California and the

president's brother Jeb Bush in Florida—and none of them wants to take

the heat for cutting the Medicaid program on their watch.

 

A group of associations representing family physicians, dentists,

hospitals and others warned in a separate letter that Medicaid cuts

" would drastically unravel an already frail health care safety net. "

 

Two years ago, a Bush plan would have converted federal spending on

Medicaid into block grants instead of basing spending on actual costs

for care. The plan also proposed a 10-year cap on federal liabilities

for health care spending on the poor.

 

In his campaign for re-election, Bush promised to cut the federal

deficit in half by the end of his second term. Spending commitments

already include the wars in Iraq and Afghanistan, at cost of more than

$5 billion a month; the privatization of Social Security to the tune of

some $2 billion of new federal borrowing; the kicking-in of the new

prescription drug program for seniors; making Bush's first-term tax

breaks for the rich permanent; and elimination of the " alternative

minimum tax, " which has prevented multimillionaires from getting away

with a tax bill of zero.

 

Even before these latest giveaways to the rich, federal tax revenues as

a share of the gross domestic product represent the smallest share

since

1959. The conservative strategy is to deliberately squeeze the budget

in

order to justify the draconian cuts being prepared.

 

Bush's budget negotiators are targeting the small amount of social

spending that remains in the budget, as well as " entitlements " such as

Medicaid, Medicare, veterans health care and Social Security. Warning

about what is in store in Bush's second term, New Hampshire Republican

Judd Gregg, due to take over as chairman of the Senate budget

committee,

was quoted in the Wall Street Journal as saying, " This cannot be a

guns-and-butter term. You've got to cut the butter. "

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