Medicaid overhaul will hurt poor people
July 20, 2005
The nation's governors have finally said uncle.
At the recent National Governor's Association meeting in Iowa, they gave in to the Bush administration's reckless plans for slicing up the nation's health-care safety net.
They rightly focused on the largest problem most of them face, both fiscally and politically: What to do about their states' skyrocketing health-care costs. Their eventual
solution? Make poor people pay for it.
Medicaid -- a joint state- and federal-funded program that provides health insurance for the poor -- has been a budget buster for just about every state in recent years. Most states have instituted cost-control restrictions this fiscal year -- 43 states limited access to prescription drugs in some way, 15 tightened eligibility and nine cut benefits.
Since the first Bush term, the White House has been pushing a plan to turn the federal contribution to Medicaid into a block grant, which would leave states holding the bill for the upwardly spiraling costs. States have in turn been urging the feds to either pay more or relieve them from the long-standing federal rules that are designed to protect Medicaid's beneficiaries.
But this spring, Congress passed a budget plan that made it clear that Washington is in no mood to give out more money. The budget blueprint, passed at the administration's urging, would cut Medicaid spending by $10 billion over the next five years, while handing out another $106 billion in tax cuts over the same time period.
So the governors circled their wagons at the Iowa meeting and emerged with a plan to trim the program's costs before Congress does it for them. At its core is a proposal to allow Medicaid to begin charging co-pays -- the first step in devolving the safety net's costs to the people it's supposed to be helping, people who are already living at the poverty level.
The governors' plan also asks for more "flexibility" in designing the program. That would mean the end of a national standard for what level of health care is considered a basic need in America. It would likely also mean forcing poor people to face the same sorts of bizarre hurdles that welfare reform presented.
One example of what states may do with their new flexibility can be found right in Iowa. There, a pilot program wields co-pays as incentives for healthier choices: lose weight and you don't have to pay anything for your care; keep packing on pounds and it's coming out of your own pocket.
Instead, a better option would have been to invest in prevention by encouraging doctors' office visits where patients could learn about nutrition. But then, that wouldn't be in keeping with the declared intent of the incoming National Governors Association chair, Arkansas Republican Gov. Mike Huckabee, whose focus is on personal responsibility in health care.
While some Democrats made meek noises about the co-pay proposal, all 50 governors signed onto the larger plan. That leaves nobody but health-care advocates standing against Medicaid's erosion.
The governors' plan does demand greater rebates from drug companies, and some governors noted that they wouldn't exercise their co-pay options.
But if Congress embraces the governors' proposals, America will have discarded a central tenet of its once Great Society -- that there exists a basic standard of health care that even those who can't pay for it deserve.
Kai Wright is editor of BlackAIDS.org, and lives in New York City. He can be reached at firstname.lastname@example.org.