[NYAPRS Enews] GOP Medicaid Plan Would Slash N.Y. Funding , Cut Senior Benefits

[Harvey Rosenthal]

NYAPRS Note: Thanks to Lauri Cole for the following pieces. 

 

GOP Medicaid Plan Would Slash N.Y. Funding 

Proposal Would Convert Program To Block Grants

By Brian Tumulty  Gannett News Service  May 10, 2011  

 

WASHINGTON - A House Republican plan to convert Medicaid into a federal
block grant program and repeal last year's health care reform law would
remove 2.17 million New Yorkers from Medicaid's rolls by 2021, according
to a new report.

New York's enrollment is around 4.8 million now and is expected to grow
to 5.64 million by 2021.

Under the current system, states and the federal government share the
cost of treating Medicaid's poor, disabled and elderly patients. New
York picks up 50 percent of the cost and splits part of that with county
governments.

The GOP House plan stands almost no chance of being adopted in the
Senate, although nine Senate Republicans announced a budget proposal
Tuesday that also would convert Medicaid into a block grant program.

Both Republican proposals come at a time when the state could use more
federal Medicaid money rather than less.

The plan would force states to reduce eligibility for Medicaid and
institute waiting lists for nursing home admissions, according to the
report from the nonprofit Kaiser Commission on Medicaid and the
Uninsured.

"Program cuts are likely because states have held rates of increase in
spending per enrollee below those of other payers," the report said.

Medicaid spending increased an average 4.6 percent per participant
annually between 2000 and 2009 - more slowly than health care costs
increased in the private sector.

Kaiser estimated Medicaid costs will escalate 6.1 percent annually per
person in the coming decade because a larger percentage of participants
will be senor citizens and disabled people who require more expensive
services.

Under New York law, state residents can keep their homes and
tax-sheltered retirement savings while placing elderly parents in
nursing homes at Medicaid's expense, according to Brian Blase, a policy
analyst at the Center for Health Policy Studies at the
conservative-leaning Heritage Foundation.

Blase supports the Republican proposal for block grants because it would
force states to reconsider their Medicaid expenditures.

"If you want to provide safety program, you can't have 25 percent of
Americans in it," he said.

New York already is looking to close a financial gap in the current
program with a state Medicaid Redesign Team appointed by Gov. Andrew
Cuomo.

"Our approach is to find Medicaid savings, and we believe we can do that
without taking away anyone's health care," said Peter Constantakes,
spokesman for the state Department of Health.

Westchester County, for example, plans to close four mental health
clinics at the end of June and turn those services over to non-profits.
The clinics serve 24,700 Medicaid patients.

Democrat Ken Jenkins of Yonkers, chairman of the Westchester County
Board of Legislators, said totally eliminating those services would be
counterproductive.

"If we don't provide good health care services for these people, they
end up in jail," he said.

House Republicans are still working out details of how Medicaid block
grants would work.

Freshman Republican Reps. Tom Reed of Corning and Nan Hayworth of
Bedford, Westchester County, say block grants would help overhaul
Medicaid the same way they worked as a part of welfare reform in 1996.
The Temporary Assistance for Needy Families program set time limits for
welfare benefits and emphasized job placement.

"Make it a more straightforward, simpler system," Reed said of Medicaid.

He favors legislation that would allow states to limit eligibility for
the program.

Hayworth said block grants would give states "an incentive to manage
Medicaid as effectively as they can."

However, federal block grants wouldn't address increased demand for
Medicaid services during a recession.

"Block grants don't adjust during a recession," said Diane Rowland,
executive director of the Kaiser Commission on Medicaid and the
Uninsured.

Democrats see the proposal as an effort to destroy part of the social
safety net.

"They are using legitimate concerns with the deficit to get rid of every
social program they have hated for the last 70 years," said Rep. Eliot
Engel, D-Bronx. "The Republican extremist philosophy is almost like
survival of the fittest. They don't care about taking care of people's
health care."

Rep. Nita Lowey, D-Harrison, Westchester County, said Republicans
"haven't come up with any real reform."

"It is cost-shifting on the backs of states and beneficiaries
themselves," she said.

Nationwide, Medicaid covers four of every 10 births and seven of every
10 nursing home residents. In New York, Medicaid covers half of live
births and 76 percent of nursing home residents.

Twenty-one percent of Medicaid spending in New York goes to hospitals
and clinics. Twenty percent goes to managed care and the Family Health
Plus program. Eighteen percent goes to mental health and developmental
disabilities programs. Fourteen percent goes to nursing homes, and 12
percent goes to home care and personal care.

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

 

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

By Jennifer Steinhauer, New York Times, May 11, 2011 

 

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 Paul D. Ryan 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 Georgetown 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. Ryan 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 Ryan 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 Eric Cantor of Virginia, the House
majority leader, said Tuesday, "Medicaid is a very important part of our
plan." 

While the House passed the Ryan 2012 budget that includes changes to
Medicare and Medicaid, as dead on arrival in the Senate. 

Another budget proposal offered Tuesday by Senator Patrick 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
John D.

Rockefeller IV of West Virginia sharply criticized several of the ideas
for reshaping Medicaid, calling broad-based cuts "almost beyond my moral
understanding." 

 

 

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