No to shredding Medicaid's safety net -- June 16, 2011 column

By MARSHA MERCER

Nobody wants to be poor or sick, but being both in America soon may get a lot worse.

Congressional negotiators who are hammering out a deal to raise the national debt limit reportedly are eyeing Medicaid, the health program for the poor, as the biggest source of spending cuts.

“Medicaid suddenly looks like the sacrificial lamb,” says Sen. Jay Rockefeller, D-W.Va. “Absolutely no.”

But with both Medicare and Social Security off the table, Medicaid is a tempting target. Even though it has a huge constituency -- Medicaid covers one in four Americans – its enrollees are poor children and their mothers, the disabled and seniors in nursing homes. Many enrollees don’t vote and they surely don’t hire lobbyists, which in Washington makes them nearly invisible.

Few politicians stand up for the poor – or for the shared American values of half a century ago.

On Monday, though, the senator whose name is synonymous with great wealth talked about the sense of mutual obligation and community that LBJ’s vision of a Great Society ignited in the 1960s with Medicaid, Medicare, Social Security, VISTA and the Peace Corps.

“There’s no government program that more fully embodies our nation’s tradition of community than Medicaid,” Rockefeller said on the Senate floor. “Medicaid is part of the fabric of our great nation.”

That fabric is in danger of being shredded. Under Medicaid’s federal-state partnership, anyone who meets certain criteria is eligible for benefits. During economic downturns, its ranks grow rapidly. Cash-strapped states are struggling to cut back on optional services and some are demanding more flexibility to cut eligibility.

The budget plan passed by House Republicans cuts Medicaid by upwards of $750 billion over 10 years and turns the program into a block grant, allowing states to remake the program as they see fit. The Senate has rejected the House plan. The bipartisan negotiations over the debt ceiling are unlikely to go that far, but various ways to cap Medicaid are being considered.

Rockefeller and 36 other Senate Democrats sent Obama a letter June 7 saying they will oppose attempts to change Medicaid into a block grant.

“We are unwilling to allow the federal government to walk away from Medicaid’s 68 million beneficiaries, the providers that serve them, and the urban and rural communities in which they live,” the letter said. Four additional Democratic senators sent separate letters.

In West Virginia, Medicaid covers the cost of 50 percent of all births. Nationally, it covers 40 percent of all births. But even in West Virginia, the two Democratic senators are divided; Sen. Joe Manchin didn’t send a letter to Obama.

After he sent his letter, Rockefeller said, “We’re counting on the White House to stand firm on our values here.”

While Obama did expand Medicaid to cover millions more adults through his health care reform law, the president has left debt-ceiling negotiations to Vice President Joe Biden. Obama seems more eager to use Medicaid as a campaign issue next year than to hold the line now.

At a Democratic National Committee fundraiser in Boston last month, Obama said: “We’re slashing Medicaid so that poor kids or middle-class families who’ve got a child who’s autistic…or has some other disability is not going to be cared for. That’s not the America I believe in. That’s not who we are…And so I think this will be a very clarifying debate between now and November of next year. And I am confident that if we get our message out, that we will win. ”

To be sure, Medicaid hardly exemplifies government that works as intended. Studies have shown that adults on Medicaid have difficulty accessing out-patient care. A new study in this week’s New England Journal of Medicine found that children with Medicaid wait longer for appointments with specialists, if they can get appointments at all, than do children with regular insurance.

There’s a reason Congress traditionally has exempted entitlement programs like Medicaid from deficit-reduction measures.

As Rockefeller said in the Senate, “Some people are born wealthy. Some people are born very poor. Some people are born in between. Some people are born wealthy and then become poor. Some people are born poor and then become wealthy. But while they are down, they have a safety net, and it is called Medicaid.”

© 2011 Marsha Mercer. All rights reserved.
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