Medicaid and Missiles

Congress is currently responding to the problems put forth with The Bush Administration’s 2009 budget (also see the Senate’s “real explanation of the 2009 budget”).

The budget (released Jan 2008) calls for a 30% increase in defense spending (but interestingly, no spending at all on Afghanistan or Iraq after 2010, and only partial funding until then) along with huge cuts in virtually every social service sector (education, clean water, transportation, even renewable energy sources!), with healthcare, specifically programs like Medicaid and Medicare, bearing the brunt of the burden.

Brilliant. Just when the country is in an economic slump – when people actually NEED social services – cut them. Because Medicaid has traditionally been funded by federal funds matched against States funds, these cuts shift much of the cost of healthcare to the State governments, which are even more short on cash. The Center for Budget Policy and Priorities gives the breakdown on how all federal funding of state programs was cut.

The proposed tax cuts would cut Medicaid spending by 17% over the course of 5 years, and would stop increasing funds to Medicare, even as the baby boomers have expanded the number of people qualifying for the program. The cuts reduce payments for school clinics, nursing homes, and teaching hospitals, virtually removing the minimal health safety net we have in place. Much of the Medicaid cuts would be to teaching hospitals, where the vast majority of people eligible for Medicaid receive care. The Greater New York Hospital Association calls it “the worst attack on hospitals, nursing homes, and home health services that New York’s health care community has ever seen from a United States president”.

Since 1965, Medicaid payments have been used to subsidize resident and intern training at teaching hospitals, which has always been justified as these are the clinicians providing much of the care for Medicaid recipients. Quoted by the NYT, Dennis G. Smith (the director of the federal Center for Medicaid and State Operations) says, “We believe that paying for graduate medical education is outside the scope of Medicaid’s role, which is to provide medical care to low-income people,”. It worries me that Mr. Smith (and our current Administration) cannot make the connection between providing medical care to low income people and paying the people who provide this care!

Congress has been fighting the whole way – and did manage to get the Children’s Health Insurance Act (SCHIP) reauthorized by the White House, albeit with some restrictions on income levels. Keep it up – I forget where I read this, but someone said that America prides itself on its government, not religion or culture or even our economic prowess, above all other qualities of a nation; that American politics is what defines us for the world.

Make us proud, Congress, make us proud.

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See also: Senatory Clinton’s Statement about the budget and its effects on New York:
http://www.senate.gov/~clinton/news/statements/details.cfm?id=291885&&