December 22, 2005
BAD SANTA
One chance left to block worst damage!
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CHENEY: Tie-breaking Scrooge |
Vice-President Dick Cheney cast a tie-breaking vote in the Senate Wednesday morning to pass a final budget deal that whacks Medicaid—big time.
New "reforms" could require low-income Medicaid beneficiaries living with HIV/AIDS to come up with $120 co-pays for each Combivir prescription and $160 copays for each day of hospital treatment—or go without lifesaving medical care.
The final budget deal includes $1 billion a year in new co-payments for very low-income Medicaid beneficiaries, several billion dollars a year in new Medicaid benefit cuts, and about $50 billion in tax cuts for profitable corporations and the very wealthy.
Five Republicans voted against the measure (several of them informed by discussions about Medicaid with AIDS activists during the Campaign to End AIDS' Advocacy Day last month: Gordon Smith of Oregon, Susan Collins and Olympia Snowe of Maine, Lincoln Chafee of Rhode Island, and Mike DeWine of Ohio.
All Democratic senators voted no, including Christopher Dodd of Connecticut, who hobbled back to Washington after knee surgery.
Senator Robert Byrd (D-WV) raised a point of order prior to passage of the budget bill that will require an additional vote in the House of Representatives, which gives Housing Works and other advocates for the poor and disabled one more shot at blocking its worst provisions. To get involved, e-mail Michael Kink at kink@housingworks.org. Read on for details on the worst parts of the budget bill.
Details on the worst parts of the budget bill
The conference agreement decreases access to needed care for millions of low-income children, parents, seniors and people with disabilities but protects corporate special interests, namely, managed-care companies and drug manufacturers.
The conference agreement allows states to impose substantial and harmful cost-sharing charges on Medicaid beneficiaries:
Under the agreement, most beneficiaries with incomes between 100 and 150 percent of the poverty line could be charged co-payments up to 10 percent of the cost of the service. These beneficiaries could be charged co-payments of $100 to $160 for the typical hospital day that costs from $1,000 to $1,600. For beneficiaries with incomes over 150 percent of the poverty level, the risks are even higher: They could be charged unlimited premiums to participate in Medicaid and could be charged co-payments up to 20 percent of the cost of both needed health-care services and some prescription drugs.
These costs would be prohibitive for many services and drugs. For example, Zyprexa, a mental health drug, costs $500, and Combivir, a drug to treat HIV, costs $600 per prescription, leading to co-payments as high as $100 or $120.
In addition, the conference agreement would increase co-payments for prescription drugs for nearly all Medicaid beneficiaries. It would also give states the ability to allow providers to deny needed services to beneficiaries if they are unable to afford the co-payments and to terminate eligibility for failure to pay premiums.
The conference agreement would permit states to cut back on benefits for nearly all of the 29 million children enrolled in Medicaid:
The conference agreement would go beyond even the harmful benefits restrictions of the House reconciliation bill, allowing states to restrict benefits for nearly all children in Medicaid, including those whose families have little or no income.
Although the agreement includes a provision to provide "wrap-around" comprehensive coverage to children through the Early and Periodic Screening Diagnostic and Testing Program (EPSDT), this wrap-around would in practice provide little assurance that children would actually obtain the care they need, which they are currently guaranteed. In addition, many parents and pregnant women could see their benefits scaled back.
The conference agreement would make it harder for low-income seniors to obtain needed long-term care:
The conference report not only adopts most of the punitive provisions in the House-passed bill to restrict eligibility for Medicaid long-term care services, but includes many of the provisions in the Senate bill as well. Under the conference agreement, the savings in this area would be 11 percent larger than under the House bill, and seven times larger than under the Senate bill.
The largest single source of the savings in the conference report comes from a provision that would penalize many non-affluent individuals who make modest gifts to relatives or charity and then experience an unexpected decline in their health several years later that causes them to need long-term care.
The conference agreement imposes an unwarranted citizenship documentation requirement that would likely decrease Medicaid coverage among eligible U.S.-born citizens, especially elderly African-Americans:
The bill also requires that citizens applying for Medicaid provide a birth certificate or passport to demonstrate their citizenship. The requirement is intended to deter illegal immigrants from falsely entering Medicaid, even though the HHS Office of the Inspector General did not find any substantial evidence that such false applications were a problem.
This provision will create serious barriers for native-born citizens who apply for Medicaid but lack a valid birth certificate or passport, like homeless people or people with mental illness. A large number of elderly African-Americans might be unable to get Medicaid because they were born in an era when African-Americans (especially those in the South) had less access to hospitals and thus never received birth certificates. One study estimated that as many as one-fifth of African-Americans born around 1940 lack a birth certificate. Other minority applicants may also find themselves subjected to greater discrimination because of these requirements.
The conference agreement does not obtain reasonable savings by reducing overpayments to Medicare managed care plans or to what Medicaid pays for prescription drugs:
The Senate reconciliation bill avoided provisions that harm low-income people by achieving such reasonable savings as eliminating the Medicare HMO "slush" fund, in accordance with the recommendation of the independent Medicare Payment Assessment Commission (MedPAC). The Senate bill also achieved savings by increasing the rebate that drug manufacturers pay the Medicaid program.
These reasonable cost-saving provisions are almost entirely absent from the final conference agreement, leaving low-income people to pay the price through cost-sharing increases and benefit restrictions that will reduce access to needed health care.