Last week, representatives of the nation's governors went to Washington to present their ideas on Medicaid reform, but rather than clarifying the picture, they may have muddied it further.
Trying to stave off an anticipated $10 billion cut to the program, Govs. Mark Warner (D-Va.) and Mike Huckabee (R-Ark.) appeared before Congress on behalf of the National Governors Association with a bipartisan plan to strengthen Medicaid. But mixed in with appreciative comments, lawmakers voiced some misgivings.
The hearings held by the Senate Finance Committee and the House Energy and Commerce Committee came as the Bush administration and Washington legislators look at ways to cut and revamp the program.
The governors' proposal outlined several steps that Warner and Huckabee said have been unanimously agreed upon. They include changing policies for drug pricing and asset transfers and adjusting the judicial system so that states can make decisions about optional populations in Medicaid without fear of being sued by the federal government.
But one proposal, in particular, was greeted with skepticism by members of the Senate and House committees-a plan to have beneficiaries pay higher copayments for services. Huckabee acknowledged possible opposition to the idea and, in presenting that part of the proposal, said it would discourage overuse of services and allow for expanded coverage in some states.
But some lawmakers, especially Democrats, challenged that reasoning. While states have protested what they see as a shifting of Medicaid costs onto them, the states in turn are proposing shifting costs to patients, some lawmakers said. "The studies I have seen suggest that increasing cost-sharing can undermine access to care," said Sen. Max Baucus (D-Mont.), the ranking minority member on the Finance Committee.
Warner and Huckabee said federal law prohibits states from charging some populations copayments and in other instances, the copays that states are allowed to charge haven't increased since 1982. To keep Medicaid financially viable, they said, beneficiaries must take personal responsibility for their healthcare.
Again, that argument didn't fly with some. "It appears that in the name of personal responsibility, the NGA proposal will make it much more difficult for children and pregnant women to get needed services," said Rep. John Dingell (D-Mich.), the ranking minority member of the Energy and Commerce panel.
Georges Benjamin, executive director of the American Public Health Association, said if patients skip healthcare because they can't afford the copays, or don't want to pay them, it could lead to more serious health problems that will be more expensive for the system.