Medicaid changes to spark battles

0 Comments | Oakland Tribune, Mar 9, 2008 | by Barbara Barrett

WASHINGTON -- The White House is facing yet another showdown with the Democratic-led Congress, this one over tweaks in a set of obscure rules that are understood by almost no one but could affect millions of low-income children and adults.

In the past year, the administration has sought rule changes that would shave $15 billion in the next five years from Medicaid, the much-maligned government program that pays for health care for the nation's poorest citizens.

The changes have consumed health-care leaders across the country. In rural North Carolina, a hospital chief wonders whether she must end newborn deliveries. In Kansas City, Mo., a massive regional medical center may have to turn away some uninsured patients.

Hospital leaders and local government officials across the country say that if Congress doesn't act to block the regulations, patients will lose. They say that the rule changes, which would be enacted around Memorial Day, would force some rural hospitals into the red.

"The sense of urgency is that both the Senate and Congress need to act now," said John Bluford, the chief executive officer of Truman Hospital Systems in Kansas City and the chair-elect of the National Association of Public Hospitals.

If the rules go through, Bluford's hospital could lose $37 million next year, almost 9 percent of his budget. He fears that he might have to restrict health care for indigent patients to only the poorest, and only to those living in Kansas City and surrounding Jackson County.

The Bush administration says the changes come as part of a needed examination of a massive federal program that, they say, has suffered what federal Medicaid chief Dennis Smith called "mission creep."

"What really is the role of Medicaid? Raising these areas of concern is something everyone should be aware of," said Smith, the director of the federal Centers for Medicare and Medicaid Services. He pointed to past Government Accountability Office reports showing waste or shoddy oversight in programs.

Still, around the country, hospital administrators are meeting in boardrooms, calling on lawmakers and worrying about where the money would come from. In Congress, lawmakers are holding hearings and releasing reports about the changes' impacts.

The regulations would cut payments for educating doctors, for rehabilitation, for children's health programs and for general Medicaid reimbursements. They're complex and aren't understood even by those who are charged with caring for residents.

Congress imposed a moratorium on two of the rules last year. The first would change the definition of a "public" hospital and lower reimbursements to some hospitals. The second would cut contributions to teaching hospitals for the education of medical residents. The congressional stopgap expires May 25, however, forcing a fast- approaching deadline.

Legislation from Sen. Jeff Bingaman, D-N.M., would extend the moratorium one more year, beyond Bush's term as president. It has the support of a majority of the Senate and more than 200 members of the 435-member House of Representatives.

Supporters say Bush would veto any free-standing bill. So Bingaman must tack his moratorium onto "must-sign" legislation such as the supplemental war-spending bill.

The cuts come as part of a larger effort by the federal Centers for Medicare and Medicaid Services to pare its costs. Smith told Congress in November that the changes would "ensure the integrity" of Medicaid and that taxpayers receive "the full value of their dollars."

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Some observers agree, saying that the rules are part of necessary changes to a bloated entitlement program that's paying for services unrelated to Medicaid's purpose.

"It's important to start to bring about more accountability. These are just small steps," said Nina Owcharenko, a senior policy analyst at the conservative Heritage Foundation policy-research center.

"Congress should really let these regulations go through," Owcharenko said. "By doing another moratorium, Congress is saying we're going to keep the mess because we don't have the fortitude to address the underlying problems."

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