As the House and Senate debate respective budget proposals this week, looming cuts to healthcare programs seem inevitable.
For example, it's no longer a question of whether Medicaid funding will be cut, but of how much.
The House Budget Committee voted last week to approve a plan that calls for $69 billion in cuts over five years to mandatory spending programs, including Medicare and Medicaid. In his fiscal 2006 budget plan, President Bush proposed revisions to Medicaid that he estimated would save $60 billion over 10 years and $14 billion over five years. Later, the nonpartisan Congressional Budget Office projected that Bush's plan would reduce Medicaid spending by $9 billion over five years. Meanwhile, the Senate Budget Committee passed a budget proposal with $32 billion in cuts over five years to mandatory spending programs.
Both chambers are expected to pass budget legislation this week, before members begin a two-week recess that starts March 18.
For Washington outsiders, the numbers attached to the budget blueprints can be confusing, because a budget resolution does not detail how the cuts will be achieved. For example, the House Budget Committee's version does not say how the House Energy and Commerce Committee will have to change the Medicaid program to achieve the roughly $14 billion in Medicaid savings that it calls for.
That committee could choose to adopt some or all of the president's Medicaid proposals or cut other programs more deeply to avoid steep Medicaid cuts. It could also ignore the President's proposals and create a whole new set of Medicaid reductions.
"I think what we should look for are stability and good policy," said Jack Ebeler, president and chief executive officer of the Alliance of Community Health Plans. Ebeler has been studying federal budgets for three decades.
"If you're a hospital, you worry a lot when you see the words Medicaid or Medicare and the word cuts behind them," Ebeler said. "When they start rolling out cuts, you just hope and trust that good policy is part of the cuts, if those cuts must be made."
The key, Ebeler said, is for the budget to follow policy, and not the other way around.
Still, the healthcare industry watches, waits and worries. A pair of reports released by the Center on Budget and Policy Priorities last week said the budget resolutions could actually lead to larger Medicaid reductions.
"The cuts proposed in low-income mandatory programs likely would result in increases in the number of low-income Americans who are uninsured or underinsured," Sharon Parrott and Isaac Shapiro wrote in one of the reports.
Also, there appears to be concern among lawmakers arising from President Bush's request that Congress slow the growth of Medicaid.
Some Senate Republicans say the overall budget reductions should go deeper than what the House and Senate budget committees have proposed.
"I think the number could be a lot larger," Sen. John Ensign (R-Nev.), a member of the Senate Budget Committee, told reporters. "In the future we're going to have to go a lot farther because (the overall budget) is unsustainable the way it is."
Others say cutting entitlements is essential but are having to think long and hard about Medicaid.
"I am not sure this is the right one, but you are going to have to have some cuts to entitlements," said Sen. Sam Brownback (R-Kan.). "We do have a top-line number that I think we need to get down. I think there will be reallocation efforts."
Sen. Jon Corzine (D-N.J.) suggested the budget shouldn't put a cap on federal Medicaid spending or shift Medicaid cost burdens to state or local governments.
House Budget Committee Chairman Jim Nussle (R-Iowa) said Republicans believed they could be more aggressive than the president in reining in future spending on entitlement programs, but that the budget plan is a good step forward.