Bush's Stealth Attack On Medicaid

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Bush's Stealth Attack On Medicaid

by Ramon Castellblanch

Hartford [CT] Courant, April 11, 2003

Under the cover of the war on Iraq, President Bush is stealthily working to devastate Medicaid - a program that provides access to health care for millions, including middle-income Americans in need of long-term care.
While the news media highlight Pentagon press conferences, the president's backers are urging us to pay no attention to efforts like this. On TV last week, former Republican presidential candidate Robert Dole said, "There will be plenty of time this year to debate Medicare reform, tax cuts and our energy strategy ... For the moment though, our country's focus should be on Iraq."

The White House is trying to move on Medicaid before there can be a debate. As the war drums were beating in January, it proposed its plan to end Medicaid as we know it. The federal government would no longer guarantee support for health care for low-income families and long-term care for many seniors. Instead, states would have a cap on federal support in 2010 in exchange for a bailout to help them with their Medicaid budget crises now. 2010 is when the baby boomers will start to need Medicaid's protection from the high costs of long-term care, such as that provided by nursing homes.

The proposal was widely blasted by groups from the AARP to the American Hospital Association. Because his proposal would be a short-term windfall for governors, the president thought he could get support from the National Governors Association. But even they wouldn't back him. Instead, they set up a task force to work up their own proposal for a federal Medicaid bailout.

As the bombs and bullets have been raining on Iraq in the past few weeks, the Bush administration has been pushing the task force to quickly come up with a plan similar to its own. In a style reflective of the Bush administration, the task force has been meeting behind closed doors with no formal way for the affected public to be involved.

According to Families USA, the administration's timetable for the task force is to have it come up with its own proposal by early May. They're looking to work out a deal with the governors by the end of next month. If things go according to plan, by Memorial Day we'll find out that the White House and the governors are working together to end Medicaid as we know it.

If Bush's plan works, it is hard to imagine that Gov. John G. Rowland would not be one of the first in line to swap his state's guaranteed federal support for Medicaid for some quick cash. It could give him new ways to steer Medicaid dollars to the insurance industry. Also, in testimony he gave the U.S. House supporting the Bush plan, Rowland said that one advantage of Bush's proposal is that it would allow him to unilaterally implement a proposal he has already made to give Connecticut one of the most draconian sets of nursing home eligibility rules in the country.

Fortunately, there is a plan to counter this attack on Medicaid. The U.S. Senate has passed a resolution calling for the federal government to give the states $15 billion to maintain their Medicaid programs. This would be less than a fifth of the $80 billion the president got for the war on Iraq, and it would maintain one of the two largest health care programs in the United States - Medicaid.

We best pay attention to this stealth attack on Medicaid now. It we don't, a lot of Americans will be shocked to find our long-term care system closing down when we most need it.

Ramon Castellblanch is assistant professor of health education at San Francisco State University. His column appears the second Friday of every month. To leave him a comment, please call 860-241-3164. Or e-mail him at ramonc@sfsu.edu.