[Homestead] So much for "Icame to office to solve problems, not leave for future generations"
tvoivozd at infionline.net
Fri Feb 4 18:35:02 EST 2005
The Christian Science Monitor - csmonitor.com
ttvoivohd---I guess dumping Medicaid costs on the States is solving the
Medicaid problem---by Bush standards
from the February 04, 2005 edition -
Debate grows over who owns Medicaid costs
*President Bush is expected to announce trims in healthcare spending,
placing the burden back on fiscally strapped states.*
*By Alexandra Marks
| Staff writer of The Christian Science Monitor
*NEW YORK* - As President Bush prepares to present his budget next
Monday, the nation's governors have put him on notice: Don't try to
balance it on our backs.
Their top concern is Medicaid - the $300 billion healthcare program that
provides coverage for the disabled, 70 percent of the elderly in nursing
homes, and low-income people.
Its costs are spiraling upward, draining state coffers as well as the
federal treasury. The primary reason is that as more people lose private
insurance, they end up in the Medicaid safety net. Over the past four
years, the Medicaid rolls have jumped more than 30 percent. Combine that
with the growing number of elderly in nursing homes, and you get a
runaway fiscal train that both the states and federal governments agree
has to be stopped. But there's a major fight brewing over how to do it.
On Monday, President Bush is expected to propose limiting the federal
government's share of the Medicaid bill - perhaps cutting as much as $50
billion over five years. Federal spending on the program is now $180
billion a year. He'd do it by capping the federal allotment in exchange
for giving states more flexibility in running their programs.
Many governors say that's no solution, since it primarily shifts the
financial burden onto the states, most of which are struggling to keep
their Medicaid costs in check. In the past year, all 50 states have cut
benefits, restricted eligibility, or increased co-pays to keep the
program's spending manageable. Some states, like Tennessee are simply
cutting large numbers of people from the program.
Other states are experimenting with different ways to rein in spending.
In Florida, for example, Gov. Jeb Bush is proposing essentially
privatizing much of Medicaid by contracting private health organizations
to provide services.
"We could well be on a collision course where state revenues are not
expanding enough to meet the needs of the program at the same time the
federal contributions are being cut back," says Diane Rowland, executive
director of the Kaiser Commission on Medicaid and the Uninsured. "The
end result will be fewer people or services covered. There's no safety
net below Medicaid."
In what could be seen as a preemptive warning to the administration, the
National Governors Association sent a letter to congressional leaders
last month letting them know that reforming Medicaid is their highest
priority this year. But it also urged them to reject any proposed reform
that just shifts "additional costs to states." The $120 billion states
spend annually on Medicaid is already more than they spend for K-12
education. It now accounts for an average of 22 percent of state budgets.
But the Bush administration is taking a hard line. This week the new
secretary of Health and Human Services Mike Leavitt charged that some
states use "loopholes" and "gimmicks" essentially to get the federal
government to pay a larger share of the program than it should.
In a speech to the World Health Congress on Tuesday, he called them the
"seven harmful habits of highly desperate states." They include such
things as overpaying providers, charging the federal government for the
overpayment, and then having it returned to them so they can spend it
for other purposes. For their part, the states argue that overall the
program is already extremely efficient compared to other healthcare
programs. While private health-insurance premiums went up more than 12
percent, Medicaid's annual spending per capita was up only 4.5 percent.
"We can't just shift all of the risks downstream to the states while the
feds limit their exposure year to year," says Ken Thorpe, a professor of
health policy at Emory University in Atlanta.
Indeed, many states say the problem is not the way the program is
structured. It's that the states have become the de facto underwriter
for nursing home care. While the elderly and nursing home residents make
up only 6.5 million of the 50 million people Medicaid serves, they
account for 42 percent of the program's $300 billion annual price tag.
Some states believe the federal government has a responsibility to find
another way to fund their care. The Bush administration argues that its
proposal would would also allow for other types of experimentation.
Full HTML version of this story which may include photos, graphics, and
related links <http://www.csmonitor.com/2005/0204/p02s02-uspo.html>
www.csmonitor.com | Copyright © 2005 The Christian Science Monitor. All
For permission to reprint/republish this article, please email Copyright
More information about the Homestead