Medicaid Recant

Medicaid: Your days are numbered.

Gotta hand it to those Bushes: They don't back down from big-balled initiatives. On the federal level, the White House is proposing cutting $60 billion from Medicaid over the next 10 years, striking terror in the hearts of states already in the throes of a Medicaid-funding crisis.

Something's clearly gotta give -- but is crippling the states the answer? Granted, Medicaid costs have ballooned more than 60 percent over the past five years -- more than $300 billion annually.

Although funding for Medicaid falls on both the states and feds, the growing numbers on Medicaid have placed a greater and greater burden on states' budgets. In 1987, Medicaid accounted for roughly 10 percent of states' budget pies. Now, that figure is 22 percent.

As Medicaid takes larger and larger chunks out of states' budgets, an intriguing idea perhaps worth consideration is coming from none other than Florida Gov. Jeb Bush, who wants to bring his version of the fabled "ownership society" to Sunshine State Medicaid. Essentially, he is proposing a privatization of Medicaid.

As reported by The New York Times on Jan. 23, Brothah Jeb is pushing for Florida's 2.1 million Medicaid recipients to be allotted a sum of money to purchase their own health care coverage from several offered managed car plans.

"Florida, with the most radical plan so far, would not be the only state to incorporate managed care into its Medicaid program. Most states do. The difference is that other states impose strict conditions about who will be covered and for which services. Under Governor Bush's plan, the private companies would make those important decisions without government interference.

"'It's very radical,' said Joan Alker, senior researcher for the Health Policy Institute at Georgetown University. 'It seems clear that the intent is really based on the notion that the H.M.O.'s and private insurers will have substantial flexibility to make a profit at the expense of the Medicaid beneficiary, who essentially assumes the risk of not getting the services they need. That's unprecedented in Medicaid, really.'"

Maybe so. But hold up, Nellie: Isn't that the case of most HMO plans? Why should Medicaid recipients necessarily get a better plan than paying HMO customers?

"Under his plan, those eligible for Medicaid would qualify for a set amount of money each month - an amount that would rise and fall depending on their particular needs, as in the case of a patient with H.I.V., who would have a higher premium than a healthy child. The money would be used to pay premiums for a person's choice of managed-care, insurance programs, provider-service networks or community-based systems.

"The private programs, then, would be able to set up their own competing programs, some offering fuller coverage and others restricting services but offering a lower premium. The idea is that competition between the companies would hold down costs."

Perhaps. But we suspect that this proposal -- aside from being a sweet little peck on the lips to the insurance industry -- is little more than a Rube Goldbergian way of kicking folks off Medicaid. Otherwise, we don't really see how this lowers costs at all; it just kicks the problem off to the private sector. And the huge numbers of uninsured will still show up at the emergency rooms -- and those exorbitant costs, in turn, will be passed on to insured Floridians.

Meanwhile, it's not at all certain that the White House will get its way with the budget and proposed slashing of Medicaid (cool! I've always wanted to use the word "slashing"!). Congressional Republicans are hardly sold on the idea. Governors from both political parties are imploring the White House not to try cutting the federal deficit by kicking the poor deeper into helplessness.

Arkansas Gov. Mike Huckebee, a Republican who represents a state where nearly 25 percent of the population are on Medicaid, told The New York Times last month that "to balance the federal budget off the backs of the poorest people in the country is simply unacceptable. You don't pull feeding tubes from people. You don't pull the wheelchair out from under the child with muscular dystrophy."

Well, actually, you do if you're a compassionate conservative, but that's a different story. Huckabee's plea is worth noting, especially in the wake of a president obstinate on tax cuts and a possible $3 trillion "transition" cost for privatizing Social Security.

Then again, the poor don't vote and they sure as heck don't contribute to political campaigns.

That's a fundamental truth that Republican political operatives, by and large, took to heart (well, maybe heart isn't the right word) long ago.