Wednesday, August 17, 2005
Indeed, Medicaid stands, at the moment, as perhaps the underreported domestic policy issue of any real political salience. As George W. Bush’s handpicked (and predictably slanted) Medicaid Commission prepares to issue a report next month with recommendations for cutting $10 billion from the federal portion of the program over the next five years, the president has already circulated a draft proposal to Congress with the administration’s own suggestions, which focus largely on hindering state accounting maneuvers that help to bring in more federal financing.
The program, meanwhile, faces more dramatic threats from the states. Long the dumping ground for refugees of the slowly collapsing employer-based healthcare system, Medicaid's ranks follow countercyclical patterns but have consistently expanded over time. (Currently the program covers about 53 million people.) That growth, combined with the general rise in health-care costs, has helped to swamp state budgets and provoke a harsh response from governors. The Bush administration has encouraged such responses by loosening restrictions on states seeking federal waivers to rejigger their programs. The general thrust of recent waiver reforms in the states -- increased cost-sharing with recipients and reduced services -- has been straightforward, and the results have been predictable: reductions in coverage and care (both PDFs). The National Governors Association (NGA) is now calling for (PDF) a series of national Medicaid policy changes along these same punitive lines.
National Public Radio's Morning Edition had a brief discussion of some of the proposed changes at the state level yesterday and you can listen here.