Proposed Medicaid Changes: Screwing The Neediest

The House and Senate must attempt to resolve their differences on changes to Medicaid evident in their respective bills.  The House bill would make changes that would have a large and lasting impact.  The Senate version would conserve (and possibly enhance )this increasingly important program.



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But senators of both parties, advocates for poor people and public health groups, including the March of Dimes and the American Academy of Pediatrics, oppose many provisions of the House bill. The changes, they say, would harm children and disabled people of all ages who rely on Medicaid.

The Senate bill would keep benefits intact. It would expand Medicaid, by allowing parents of severely disabled children to buy coverage and by stepping up efforts to enroll people already eligible.

The House bill would put a greater burden on those covered.  In certain cases, providers could, apparently, refuse treatement.

The House bill makes three major changes:

¶States could charge premiums and higher co-payments for a wide range of Medicaid benefits, including prescription drugs, doctors' services and hospital care.

¶States could scale back benefits, capping or eliminating coverage for services now guaranteed by federal law.

¶States could end Medicaid coverage for people who failed to pay premiums for 60 days or more. Pharmacists could refuse to fill prescriptions, and doctors and hospitals could deny services, for Medicaid recipients who did not make the required co-payments.

This is a 180 degree change from current law under which provision of services can't be denied.  The proposed changes are estimated to have an impact upon millions of individuals, many of them children.  Currently, the law forbids co-payments for those under age 18.    

In a detailed analysis of the House bill, the Congressional Budget Office predicted that 70,000 to 110,000 people would lose Medicaid coverage for failure to pay premiums. It estimated that states would establish co-payments for 11 million Medicaid recipients, half of them children, and increase existing co-payments for an additional 6 million people.

"In sum," the budget office said, "we expect that about 17 million people - 27 percent of Medicaid enrollees - would ultimately be affected by the cost-sharing provisions of the bill." ...

And the Democrats, they're screaming about this, right?  Well,...

Democrats, who are generally opposed to the House and Senate budget bills, are excluded from the current negotiations. The chief negotiators on Medicaid are Representative Joe L. Barton of Texas and Senator Charles E. Grassley of Iowa, both Republicans.

So, yes, let's kick people when they're down.  Make them responsible, even if they are desperate.

Mr. Barton, the chairman of the House Committee on Energy and Commerce, said that higher co-payments were needed to "encourage personal responsibility" among Medicaid beneficiaries.

But the bottom line here is that the co-payments are likely to discourage the use of services.

In 2003, when Oregon expanded its Medicaid program, it received federal permission to charge premiums of $6 to $20 a month for certain new beneficiaries. It charged co-payments of $5 for a doctor's office visit, $2 or $3 for most prescription drugs, and $15 for some medicines.

Tina D. Edlund, research manager at the Oregon Office for Health Policy and Research, said: "The co-payments discouraged both appropriate and inappropriate use of services. Of the 90,000 people who were subject to premiums, 40,000 dropped off the rolls, and the poorest of the poor were disproportionately affected."

"We thought the premiums were relatively small," Ms. Edlund said, "but for people with very low incomes, they proved to be significant."

Senator Grassley on the far less harsh senate bill:

"It's consistent with the compassionate conservative agenda advanced by the president," said Mr. Grassley, the chairman of the Senate Finance Committee.

It's good to know that there is a compassionate conservative agenda, I assumed that it was only the subject of myth.

Here is a link to bill H.R.4241:

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Here is a link to a story about the new AARP campaign against Medicaid changes:

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