| All across the country the demands on the Medicaid system are growing, yet in spite of this reality, virtually every state is considering significant cuts to their programs budgets. Since the states are temporarily barred from decreasing the roles by making it tougher to qualify for benefits by changing the income levels for eligibility, all the states have left to cut are the reimbursement rates they pay doctors and hospitals, and "optional benefits." You know - the frivolous shit like eyeglasses, dental care, durable medical equipment like batteries for a quadriplegics wheelchair.
Medicaid is in a classic Catch-22 right now. The economy sucks, so more and more people qualify for the program, but the economy sucks so money isn't flowing in to state coffers to pay for it.
A survey released Thursday by the Kaiser Family Foundation found a record one-year increase in Medicaid enrollment of 3.3 million from June 2008 to June 2009, a period when the unemployment rate rose by 4 percentage points. Total enrollment jumped 7.5 percent, to 46.9 million, and 13 states had double-digit increases.
Because Medicaid enrollment often lags behind unemployment, this year's increase could prove even greater.
The National Association of State Medicaid Directors estimates that state budget shortfalls in the coming fiscal year, which begins in July in most states, will total $140 billion. Because Medicaid is one of the largest expenditures in every state budget, and one of the fastest-growing, it makes an unavoidable target.
"For most states, the fiscal situation is still dire, and the Medicaid cuts are significant," said Scott D. Pattison, executive director of the National Association of State Budget Officers.
Governors and legislators have managed to defer the deepest cuts because the federal stimulus package provided $87 billion to states in Medicaid relief. The cost of Medicaid is shared by the federal and state governments, with states setting eligibility, benefit and reimbursement levels within broad federal guidelines, and Washington covering the majority of the expense.
But the stimulus assistance is due to expire at the end of December, in the middle of many states' fiscal years, leaving budget officials to peer over a precipice. Congress and the White House are considering extending the enhanced payments for six more months, at a cost of about $25 billion.
The House of Representatives has passed a bill to ameliorate this problem, and President Obama has included it in the budget he released this month. And you damn well know what comes next...The legislation is stalled in the Senate as 41 petulant sore losers lay down on the floor and kick and scream and say "No!"
And that Catch-22 I mentioned? Yeah, it's two-fold. When states start cutting to save money, they end up in a death spiral, because the rules say that for every dollar a state cuts, they lose at least a dollar in federal assistance to pay for the program.
Missouri has already been down this path. Hell, we blazed this trail in 2005 - and it goes nowhere good.
However, this reality does highlight what is at stake when the President and the Congress get together for their Health Care Summit next week. And it also highlights who wasn't invited to the table who ought to be: Governors. |
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