Burgeoning state budget deficits totaling $60 billion to $85 billion are projected for fiscal year 2004. Given that 49 states must show balanced budgets each year, many are taking the scissors to programs such as Medicaid. The cuts may have an adverse effect on many poor and near-poor working families insured through Medicaid and the State Children's Health Insurance Program, according to a study on Medicaid released in January by the Center on Budget and Policy Priorities.
California, Colorado, Connecticut, Kansas, Massachusetts, Missouri, Montana, Nebraska, Nevada, New Jersey, Oklahoma, Oregon, Tennessee, Texas and Washington have announced plans to trim Medicaid programs. Missouri and Texas have considered doing away with SCHIP programs.
In February, the Bush administration proposed fundamental changes in the Medicaid program. The Bush proposal would do away with federal rules that now apply to about one-third of all Medicaid recipients and two-thirds of all Medicaid spending. The proposal would give states power to reduce, eliminate or increase benefits for millions of low-income people, including many who are elderly or disabled. But some have argued that it will take more than this to address cuts in the state-run programs that could force many physicians to shut their doors to Medicaid patients.
More recently, the House, in its FY 2004 budget resolution, voted to cut some $93 billion in Medicaid spending over the next 10 years. In a letter to House/Senate budget committee conferees, AAFP Executive Vice President Douglas Henley, M.D., urged the legislators to uphold funding for the program. "In context of the current financial hardship many families are facing, now is particularly an inopportune time to scale back on our nation's health care safety net," he wrote. At press time, the conferees had avoided the $93 billion cut, heeding the requests of the AAFP and other organizations.
Family practice residents are watching the Medicaid drama unfold as they make their decisions on where to practice.
"It's very serious for docs who are going to be looking (for a practice), but it is also serious for patients in the inner cities, where Medicaid is their health insurance," said Yvette Rooks, M.D., assistant professor at the University of Maryland School of Medicine's family medicine department in Baltimore. "Our residents get some practice management (training) from our clinical director, and they say they are going to leave the state or go practice in the county, where the payer mix is different."
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