G.O.P Medicaid Changes Could Cut Coverage for the Aged

[Guest guest]

Critics Fear G.O.P.'s Proposed Medicaid Changes Could Cut Coverage for the Aged

By JENNIFER STEINHAUER

WASHINGTON — As Republicans inch away from their plan to reshape the nation's

Medicare program, their equally transformative ideas for Medicaid, now largely

in the shadows of the budget debate, are moving front and center.

While the largest number of Medicaid recipients are low-income children and

adults, who tend to be far less politically potent voices in battles over

entitlement programs than older voters, the changes to Medicaid proposed by

Representative D. of Wisconsin, the House budget chairman, could

actually have a more direct impact on older Americans than the Medicare part of

his plan.

The House plan would turn Medicaid, which provides health coverage for the poor

through a combination of federal and state money, into a block grant program for

states. The federal government would give lump sums to states, which in turn

would be given more flexibility and independence over use of the money, though

the plan does not spell out what the federal requirements would be.

Beginning in 2013, these grants would increase annually at the rate of

inflation, with adjustments for population growth, a rate far below that of

inflation for health care costs. As a result, states, which have said that they

cannot afford to keep up with the program's costs, are likely to scale back

coverage. Such a reduction, critics fear, could have a disproportionate effect

on Medicaid spending for nursing home care for the elderly or disabled.

By contrast, under the Medicare proposal approved by the House, no one currently

55 or older would see a change in benefits, which the House proposed to turn

into a voucher-type program.

" This is a huge deal for the nation's seniors, and it's been largely

unrecognized, " said Jocelyn Guyer, the co-executive director of the Center for

Children and Families at the town University Health Policy Institute.

" Obviously Medicaid is a program designed for low- and modest-income people. But

when it comes to nursing homes, a lot of seniors start off middle class and pay

for their care with private funds but end up using the Medicaid program. "

According to the Congressional Budget Office, in the 2010 fiscal year, 77

percent of people enrolled in Medicaid were children and families, while 23

percent were elderly or disabled. But 64 percent of Medicaid spending was for

older Americans and people with disabilities, while 36 percent went to children

and families.

According to the Kaiser Family Foundation, which analyzes health care issues, 7

of 10 nursing home residents are on Medicaid, in large part because even

middle-class patients often run through their savings while in a nursing home

and turn to the entitlement program.

The foundation recently estimated that a Medicaid block grant similar to the one

proposed by Mr. could save $750 billion over 10 years. House Republicans

also want to eliminate the expansion in Medicaid eligibility scheduled to take

place in 2014 under the new health care law, which could result in savings of

$610 billion.

According to a report released Tuesday by the foundation with the Urban

Institute, by 2012, under the plan, Medicaid enrollment nationally could be

44 million people fewer than what it is projected to be under current law, which

includes new additions to the program under the health care overhaul.

It is still possible that there will be some changes to the Medicare program

this year, but Medicaid is quite likely a more politically viable area of

change. Representative Cantor of Virginia, the House majority leader, said

Tuesday, " Medicaid is a very important part of our plan. "

While the House passed the 2012 budget that includes changes to Medicare

and Medicaid, it is dead on arrival in the Senate.

Another budget proposal offered Tuesday by Senator J. Toomey, Republican

of Pennsylvania, increases Medicare spending, while using block grants for

Medicaid in an effort to reduce Medicaid spending by 2019 to a level only $14

billion above what it was in the 2008 fiscal year.

It is likely that Democrats will strongly oppose block grants, arguing that such

a plan would shift too many Medicaid costs to states that are already slashing

their budgets. At a news conference last week, Senator D. Rockefeller IV of

West Virginia sharply criticized several of the ideas for reshaping Medicaid,

calling broad-based cuts " almost beyond my moral understanding. "

http://www.nytimes.com/2011/05/11/health/policy/11medicaid.html