BY LESLIE CHAMPLIN
Medicaid reform that caps federal outlays for Medicaid or imposes restrictions on eligibility will do more harm to Americans' health than good to America's budget. That's the message physicians and patient advocates are sending to Congress and President Bush as federal lawmakers convene their 109th session.
The medical community's concern stems from trial balloons floated by the Bush administration and members of Congress. One balloon -- which would have put federal Medicaid funds into block grants to states -- was defeated before it got much traction in the 108th Congress. However, the concept resurfaced when Rep. Joe Barton, R-Texas, promised hearings on the proposal early in the 109th Congress. Others have suggested capping federal Medicaid spending.
In a Dec. 16 letter to President Bush, AAFP and 15 other physician, hospital and pharmaceutical organizations urged him, "in your Fiscal Year 2006 budget, … do not include any reductions on the rate of growth or propose caps on Medicare or Medicaid spending. More than 40 million seniors and people with disabilities depend on Medicare. More than 52 million vulnerable Americans, many of whom are children and seniors, rely on Medicaid. With many states in fiscal crisis, Medicaid reductions at the federal level would drastically unravel an already frail health care safety net."
The letter is in keeping with the Medicaid Provider Coalition's core principles, which were discussed during the AAFP Commission on Legislation and Governmental Affairs January meeting in San Antonio. Composed of the organizations that represent primary care physicians, community health centers and community hospitals -- including the Academy -- the coalition developed the core principles to establish the medical community's position on Medicaid reform.
The core principles outline minimum provisions that should be in any Medicaid reform. Among them:
| Want your patients to become more informed about Medicaid reform and its potential impact on insured and uninsured people? The AAFP's newly enhanced Patient's Voice in Washington program offers an easy-to-read information sheet about Medicaid on its Web site, http://www.aafp.org/patientsvoice.xml. Read more about Patient's Voice in Washington. |
The medical community is not alone in its concern about Medicaid reform. In a Dec. 22 letter to Congress, the National Governors Association urged legislators to refrain from using the budget reduction and reconciliation process as the Medicaid reform mechanism. Though budget reduction and reconciliation might cut federal spending on Medicaid, they would do little to actually reform the program in a way that ensures greater efficiency in providing care, the letter warns.
"We agree that maintaining the status quo in Medicaid is not acceptable," the National Governors Association letter says. "However, it is equally unacceptable in any deficit reduction strategy to simply shift federal costs to states."
With Medicaid consuming 22 percent of their budgets, states already struggle to meet their Medicaid commitments. In the last four years, all states and the District of Columbia have imposed some restrictions by either cutting or freezing physician payments, according to the Kaiser Commission on Medicaid and the Uninsured. Federal caps or cuts would further stress states' Medicaid budgets, and -- according to a 2004 AAFP Practice Profile Survey -- the 77 percent of family physicians who take Medicaid patients would become less and less financially able to care for them.
"Limiting federal Medicaid resources would place additional pressures on providers, resulting in fewer providers able to serve Medicaid and uninsured patients, said a Kaiser Commission fact sheet, Medicaid: Issues in Restructuring Federal Financing.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
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