Making Medicaid Work
Kleyman, Paul, Aging Today
The alarming leap in national Medicaid costs from about $200 billion in 2000 to more than $320 billion this year-largely due to escalating healthcare costs, the slumping U.S. economy and employers' retreat from affordable health insurance-recently landed on news pages with the sharply criticized federal Medicaid commission appointed by the Bush administration in July, as well as the controversial reform proposal of the National Governors Association (NGA) in June.
The politics of budget crunching and tax containment, though, rest at an uneasy tangent to the policymaker's arc of analysis and consensus building. No sound bites or media coverage came of last January's release of Making Medicaid Work for the 21st Century from the National Academy of State Health Policy (NASHP), based in Portland, Maine, but this model of substantive balance and informed compromise could help to moderate the political sparring inside Washington's Beltway and, one hopes, lead to solutions for people in need, not merely campaigns for reelection.
THE WHITE HOUSE AND NGA
On July 8, U.S. Health and Human Services (HHS) Secretary Mike Leavitt named the new Medicaid Advisory Commission-initially charged with submitting a report in barely eight weeks, by Sept. 1, 2005-to outline recommendations for reaching $10 billion in spending reductions in five years beginning in 2006. The commission, including 13 voting members and a separate nonvoting group of 15 experts and representatives of relevant fields, must also deliver recommendations "to help ensure long-term sustainability of Medicaid," according to an HHS press notice. According to Congress Daily, the congressional Democratic leadership said it would not participate in the commission and said the nonvoting advisory group is insufficient.
The commission came under immediate fire from Democrats and advocates not only for allowing so little time to reach such a narrow, financing-related goal, but also for its lack of balance. Rep. Henry A. Waxman, D-Calif., author of much of the Medicaid law, told The New York Times (July 9) that the announcement "confirms that the purpose of the commission is to rubber-stamp the administration's failed Medicaid Policies." Ron Pollack, executive director of Families USA, for instance, called it "a sham that deservesand will receive-no credibility."
Previously, an 11-member bipartisan working group of the nation's governors released a paper titled "Medicaid Reform: A Preliminary Report" on June 15 (www.nga.org). Confronting the expansion of state Medicaid costs from 15% of state budgets in 2000 to 22% this year, NGA proposed a set of reforms, such as measures allowing states to increase penalties on elders for inappropriate transfers of assets to qualify for Medicaid long-term care coverage; levying co-payments, premiums and déductibles for families with children on the State Children's Health Insurance Program; and having more flexibility in designing benefits packages "without compromising quality of care." NGA's proposed changes would affect coverage of all Medicaid beneficiaries, who include 25 million children, 13 million low-income adults, 8 million people with disabilities and 7 million elders.
The Kaiser Daily Health Report for June 16 reported "unusually sharp and angry attacks" by congressional Democrats. Sen. Jay Rockefeller, D-W.V., for example, told the Washington daily, The Hill, "We wouldn't have a Medicaid problem if we didn't have the tax cuts," referring to major tax reductions prompted by the White House.
In testimony before the U.S. Senate Finance Committee on June 15, Stuart Butler, vice president of the conservative Heritage Foundation, Washington, D.C., urged Congress to encourage greater federalism, especially by permitting states "the opportunity to propose creative ways of achieving [Medicaid budget targets] within the goal of generally increasing coverage," especially among the 45 million Americans without health insurance. …