[NYAPRS Enews] Alert: Medicaid At Risk! Call Congress Today, Next Week

[Harvey Rosenthal]

NYAPRS Note: The following is adapted from materials provided by Lauri
Cole of the NYS Council for Community Behavioral Healthcare, who's
leading the fight from New York against federal proposals that would
devastate Medicaid. Please call today and next week!

 

FEDERAL POLICY ALERT * FEDERAL POLICY ALERT * FEDERAL POLICY ALERT

MARCH 25, 2011

 

 

Certain lawmakers on the Hill are working to include provisions in their
2012 federal budget resolution that (if enacted) would have a
devastating impact on states that receive federal matching funds for
state-run Medicaid and Medicare Programs. Powerful Republican leaders
are preparing a group of recommendations to incorporate into their 2012
Budget Resolution that would:
- Block Grant Medicaid funds to states and voucher Medicare funds to
beneficiaries
- Scale back or eliminate the Maintenance of Effort provisions of the
ARRA (stimulus bill)

 

ACTION REQUESTED!

 

TAKE THE FOLLOWING STEPS TODAY AND EVERY DAY NEXT WEEK

 

Contact your Congressional Representatives and both NYS Senators (see
their phone numbers at http://www.contactingthecongress.org/) and leave
the following message:

 

"I'm a registered voter from (your locality) calling to urge you to
reject block grant, voucher or other changes to Medicaid that would
cause devastating harm to Medicaid beneficiaries across our state."

See below for more details should you get into a longer conversation
with staff. 

 

Then, please send feedback from those calls to Lauri Cole of the NYS
Council for Community Behavioral Healthcare at
nyscouncil at albany.twcbc.com


 
BACKGROUND
Block Grants and Vouchers 
Block granting Medicaid funds sounds (on the face of it) like an
attractive option to lawmakers and their staff who are UNFAMILIAR with
the negative outcomes associated with such a move, and who crave
flexibility.  However, block granting federal funds to states would
result in less money to states over the short and longer-term. Block
Grant proposals would freeze the amount a state could receive in the
future based on what they receive now plus some increase that is far
below any predicted growth.  For example, one proposal would save the
Federal government $180 billion over the next ten years.

Under current law, the federal government has the flexibility to
stimulate state economies via measures such as enhancing the FMAP rate
paid to states.  Under a block grant scenario, states would receive a
fixed amount of dollars for operation of their state Medicaid Program
without respect to increases to the state Medicaid rolls due to economic
changes, catastrophic events, growth in population, or an aging
population.  This could result in increasing the rolls of New York's
uninsured.     
Under a Block Grant scenario, states would be locked in to the amount
dictated by the current federal match they receive from the federal
government (FMAP) in perpetuity. It is important to note that at this
time, New York State receives the bare minimum match (50-50) allowed by
law.  We want the ability to fight for and change the current match.
Under a block grant, we would not have that opportunity. 
Block grant funds would not keep up with inflation, or projected growth
of the Medicaid Program. Any increase in the amount that the federal
government sent to a state would not grow at the rate of health care
actual rate of growth.  It would be purposely set at a much lower rate
of increase.   New York would receive one set amount, and that amount
would be limited in growth by an amount far below expected expenditures.
This is more about saving federal dollars than providing support for the
Medicaid population.    
Lawmakers in Washington, DC need to hear from providers and consumers on
this issue.  They must not be allowed to block grant funds to states.
       
Maintenance of Effort Agreement 
Under the ARRA, states must abide by the Maintenance of Effort (MOE)
provision requiring they not alter the eligibility requirements that
were in place when the ARRA passed.  Some state leaders are now trying
to wiggle out of the MOE by seeking waivers allowing their state to
alter the basic benefits package to Medicaid and potential Medicaid
beneficiaries, and to narrow eligibility criteria in use to screen
applicants in or out of the Program.
Enactment of either of these policies will have a devastating impact on
New York and vulnerable populations served by these important state-run
programs.  Furthermore, they undermine the real value of health reform
as it extends an opportunity to receive basic health insurance and
expands access to health care for currently uninsured individuals.  

 

Medicare

There are proposals under consideration that would change Medicare into
a voucher system.  Again, this is a proposal to save federal dollars and
shift the risk to beneficiaries.  The proposed vouchers would not cover
the cost of buying basic health insurance.  Beneficiaries would have to
provide large premiums and co-pays, which they are unlikely to be able
to do. 

If Medicare turns into a voucher system, many beneficiaries would find
that their voucher would not allow them to purchase a package of
benefits comparable to that which Medicare currently provides.  

First, privatizing Medicare (as the proposal would do) would tend to
raise health costs, since traditional Medicare generally pays less to
providers and incurs lower administrative expenses than private
insurance.  

Secondly, insurers would be allowed to charge older and sicker Medicare
beneficiaries higher premiums.  

Third, insurers would surely attempt to shun enrollees in poor health
(who cost much more), as private plans do today. 

Finally, low income individuals eligible for both Medicare and Medicaid
would no longer receive help with their Medicare premiums and
cost-sharing though Medicaid. That would mean that some of the most
vulnerable low-income Medicare beneficiaries who are the sickest and
incur the most health care costs - including poor, frail people who are
very old and poor people afflicted with severe disabilities - would be
unable to afford needed care, including long term care.

----------------

 

Medicaid Advocates Expect Dem Proposal For Program Cuts

By Julian Pecquet - The Hill  March 25, 2011

 

Medicaid advocates came out of a meeting with Democrats this week
expecting the party to propose cuts to the entitlement program.
They expect those cuts would be smaller than the ones that will be in
the Republicans' 2012 budget proposal and some see them as a way for
Democrats to start the bargaining process with the GOP.

As many as 100 Medicaid advocates attended a meeting with House
Democratic staffers Wednesday to try to craft a unified response as
Republicans prepare to unveil their spending plan for next year, The
Hill has learned.
Democrats did not lay out a grand strategy or formally proposed a plan
to cut Medicaid spending but instead called on advocates to keep the
pressure on the GOP. 
"It's a huge, huge threat," one advocate said of the GOP budget
proposal, which is expected to be unveiled in the first week of April.
"Finally people are paying attention to Medicaid." 
Entitlement reform has dominated the spending debate. Republicans have
pushed for it as a way to cut spending, which is a huge concern for the
large class of freshman GOP lawmakers.
And House Budget Committee Chairman Paul Ryan (R-Wis.) acknowledged last
week that the GOP will be handing Democrats a weapon when their spending
plan comes out.
Advocates came out of the Wednesday meeting with mixed feelings. Some
criticized Democrats' late response while others praised them for trying
to unite opposition to Republican cuts that could be as high as $1
trillion. 
One lobbyist said the Democrats were five months late to the party and
now had no choice but to acquiesce to the Republican terms of the
debate. 
Earlier action could have given lawmakers time to come up with policy
solutions instead of just proposing smaller cuts, the source said; for
example, drugmakers could have been required to offer rebates for
low-income seniors enrolled in both the Medicare and Medicaid programs. 
"Democrats do not have a strategy for what they want," the lobbyist
said. "They're being largely reactive." 
The advocates did not want to go on the record since the meeting was not
public. 
Sources told The Hill the afternoon event was held in the Rayburn House
office building and lasted about an hour, with minority staffers from
the House Energy and Commerce Committee, the House Budget Committee, and
the Democratic leadership leading the show and taking questions. 
A spokeswoman for Energy and Commerce Committee ranking member Henry
Waxman (D-Calif.), a lead organizer of the event, declined to comment
about the meeting's goals but did not deny it had taken place. 
The size of the cuts on either side of the aisle is still in flux. 
Ryan last year released a block grant proposal along with Democrat Alice
Rivlin, President Bill Clinton's budget director, that cut $180 billion
from the program over 10 years. 
Advocates expect Ryan's opening salvo in the 2012 budget to be
considerably bigger - up to $1 trillion, some believe - especially since
Ryan is expected to propose a repeal of healthcare reform and an
extension of the Bush tax cuts, both of which would add to the deficit. 
Some advocates say massive cuts to Medicaid could actually be a strategy
to undermine the healthcare reform law, which expands the program to
more than 15 million Americans. 
"I think you could lose the individual mandate and so what?" one
advocate said. "But if you start destroying Medicaid ... the whole thing
starts to crumble." 
Republicans say they want to preserve, not destroy, Medicaid by making
it financially solvent over the long term. 
Budget committee spokesman Conor Sweeney said the Republican budget will
make the hard choices to tackle the long-term sustainability of
government health programs that he said the "do-nothing-but-demagogue"
Democrats have so far avoided. 
"It's premature to comment on a budget that has not been completed yet,"
he added. 
In any event, many advocates expect the proposed Republican cuts to be
so massive that they'll require the committees to transform the program
into block grants even if the budget doesn't spell that out. 
That would mean giving states a set amount of money that would no longer
increase when the economy goes bad and more people rely on government
assistance. 
Obama's budget for 2012 is projected to save Medicaid $33.6 billion over
10 years. Including impacts of other proposals on the Medicaid program,
those numbers increase to $36 billion over 10 years.

http://thehill.com/blogs/healthwatch/medicaid/151805-medicaid-advocates-
expect-dems-to-propose-cuts-to-program

 

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