Medicaid and the Budget
Earlier this week, Kate highlighted impending cuts to the Medicaid program. On Wednesday, the House of Representatives passed and President Bush praised (and vowed to sign) a budget package that will reduce Medicaid spending by $4.7 billion over five years, largely through increased co-payments and premiums and reduced benefits. A report this week from Georgetown's Health Policy Institute found that the Medicaid provisions in the budget would (1) undo the guarantee that children in Medicaid will be provided medically necessary services, (2) permit states to charge families substantial new costs that many would not be able to afford, and (3) require states to impose new and unnecessary paperwork on eligible children.
But President Bush barely mentioned Medicaid in Tuesday's State of the Union speech, and the list of his health care priorities that the White House subsequently released did not even include the word Medicaid at all.
It's no secret that Medicaid has been on the chopping block for the last few months, and given the fairly large amount of attention health care received in the 2004 election, I thought I'd take a look back at an analysis by the Lewin Group of the Bush and Kerry 2004 presidential campaign health care proposals to see if there was a section in Bush's proposal detailing reductions (or even reforms) to the Medicaid program. The analysis of the Bush proposal revealed not a word about restructuring or reducing Medicaid, but rather included only the following innocuous statement on the topic:
The Bush plan proposes to launch a nationwide campaign to sign up more of the children who are already eligible for Medicaid or SCHIP. It proposes to put $1 billion into a nationwide outreach program. The program would be implemented through states, the federal government and communities including faith-based organizations.
So the Medicaid program, despite financing health care for over 50 million American citizens, barely shows up in any statement of President Bush's health care priorities but rather only in the context of the budget as "entitlement spending?"
Seniors and disabled Americans - so called "dual eligibles" - until this year had all drug costs reimbursed. With the passage of the prescription drug benefit, Part D, these folks now pay deductibles, co-payments and full costs in the "donut hole" of coverage.
Consider the case of a disabled person or senior receiving 1400/month in Social Security Benefits. The Medicaid "share of cost" is about 700/month. When her drug costs reach the bogey 2400(?)/yr., this person almost certainly will go without medication for the rest of the year Hospitalizations and increased outpatient services the likely result. Local public hospitals and state governments will inevitably bear a good portion of the additional, uninsured medical expenses as well.
The programs are so complex. Different rules and thresholds apply to families, children, singles etc in all 50 million Americans but the case captures the basic scandal
Truly a scandal but where is the outrage?
The more we do to you, the less you seem to believe we are doing it.
— Joseph Mengele
February 4, 2006 7:15 PM | Reply | Permalink