Posted on 03/06/2005 8:27:13 PM PST by NormsRevenge
SACRAMENTO, Calif. (AP) - For all the deadly foes he vanquished on the silver screen, Gov. Arnold Schwarzenegger may be finally meeting his match - the growing medical bills of poor people.
In his rookie year, Schwarzenegger tried simply to slash the state's costs by $900 million, then backed down after roars of protest. Now he's back with a new attack, one of many experiments proposed by U.S. governors to cut states' soaring medical costs. Schwarzenegger would limit a poor Californian's dental work to $1,000 a year, steer nearly 1 million more people into managed care networks and make families pay up to $27 a month in premiums for their government-funded medical help. But advocates for 6.6 million low-income, disabled and elderly California residents are again trying to slow Schwarzenegger as he maneuvers the plan and its projected first-year $12 million in savings through the Legislature.
While Schwarzenegger has to cope with the problems of the nation's most populous state, he's not alone among governors in fighting the spiraling growth in costs for Medicaid, the $329 billion federal-state program that pays for health care for 53 million low-income Americans. In just about all the 50 states, Medicaid costs are rising rapidly and squeezing governments, poor people, doctors, hospitals and other health care providers.
California's annual medical bills for the poor have grown by $4.5 billion since 1999, and now rival the yearly K-12 education budget. Nationally, such medical costs have already passed education inside all combined state budgets, state officials report. Worse, as states have survived the worst of their financial problems, President Bush has complicated their struggle by proposing a $40 billion or more 10-year cut in Medicaid.
Governors meeting last week in Washington told Bush their cash-strapped states can't handle such cuts without hurting their poorest residents.
The combination of state and federal budget woes "puts the Medicaid program in a very vulnerable position," threatening states, beneficiaries and providers, said Robin Rudowitz, senior associate with the Washington D.C.-based Kaiser Commission on Medicaid and the Uninsured.
Dozens of states are trying to balance preserving the program with stopping its rapid growth. Rising Medicaid costs - up 40 percent in the last five years because of job layoffs and higher medical charges with no end in sight - are forcing draconian choices. Governors pressed Bush for more flexibility from their federal partners for cost-curbing experiments, an argument the administration said it is considering.
"At the state level, governors are being forced to choose between health care and education," said Raymond C. Sheppach, executive director of the National Governors Association.
Democratic Tennessee Gov. Phil Bredesen is trying to cut 323,000 people from his state's Medicaid system known as TennCare, while in Connecticut, 13,000 low-income working parents are scheduled to lose Medicaid coverage this spring. More states are demanding co-payments from users, curbing costs of prescription drugs or simply reducing benefits. In an extreme example, a Colorado lawmaker has proposed that his state seize estates of Medicaid patients after they die to recoup the growing cost to Colorado taxpayers.
Schwarzenegger's plans for slowing growth in California's $34 billion version of Medicaid - called Medi-Cal - accompany a goal to cut welfare grants by 6.5 percent and eliminate automatic cost-of-living hikes in welfare benefits. The ambition, said Sandra Shewry, Schwarzenegger's director of health services, is to design a new delivery system that gradually saves $254 million over five years rather than simply "cutting the Medi-Cal program."
But he's also proposing cuts.
In January, Schwarzenegger proposed a $111.7 billion budget that would cap dental benefits at $1,000 a year. Many states already cap such spending, as do private sector health plans. Of California's 3 million Medi-Cal dental patients, administration officials said, fewer than 100,000 had dental bills last year higher than $1,000.
The budget also proposed that at least 550,000 Medi-Cal patients with incomes above the poverty level begin paying monthly premiums for their care - $10 a month for adults, $4 monthly per child or a $27 family maximum. "We believe it's a reasonable and fair request to make that families contribute a very modest amount to the cost of their coverage," Shewry said.
But advocates for the poor, including many among the Legislature's Democratic majority, want the Republican administration to back off, focus spending cuts elsewhere and hike taxes to trim the state's red ink.
Schwarzenegger said he won't raise taxes.
Anthony Wright, president of Health Access, a coalition of groups which monitor health care issues in California, cited administration estimates that 100,000 people among the 550,000 targeted for monthly premiums will simply "fall off the program," while another 100,000 people would have to pay for major, necessary dental work out of their own pockets.
"The real savings comes from people falling off the program," Wright said.
Health care providers that serve Medi-Cal patients are also wary of the changes.
California already has one of the nation's lowest reimbursement rates, which is why many doctors and dentists don't take Medi-Cal patients and many hospitals complain about wholesale financial losses from the program.
"Last year we lost $20 million over and above what we were paid for Medi-Cal," said John G. Taylor, director of the chief executive office at Fresno's nonprofit Community Medical Centers.
The system, which runs three hospitals with more than 700 beds, lost $30 million more on Medicare reimbursement shortfalls and made much of it up through charges to insurance-carrying for-profit patients and donations, Taylor said. The state also funnels $2 billion a year in Medi-Cal funds to 24 "safety net" hospital systems to help make up such losses.
As California ponders its options, many states have already acted, according to a study by the Henry J. Kaiser Family Foundation. This year, 47 states trimmed or froze payments to health care providers, while 15 tightened eligibility requirements, nine instituted co-payments and nine cut benefits. Another 14 expanded managed care networks.
One state, however, is considering expanding its Medicaid program. Kansas Gov. Kathleen Sebelius, a Democrat, is proposing a $50 million expansion of health care to 100,000 uninsured residents by hiking cigarette taxes by 50 cents a pack.
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On the Net:
National Gov.'s Association: http://www.nga.org
National Conference of State Legislatures: http://.www.ncsl.org
Kaiser Family Foundation Medicaid Site:
http://www.kff.org/medicaid/index.cfm
Highlights of Schwarzenegger plan to trim rising medical costs for poor
http://www.bakersfield.com/state_wire/story/5337090p-5362619c.html
The Associated Press
Highlights of Schwarzenegger plan to trim state's rising medical costs for the poor:
California's current annual Medi-Cal budget: $34.1 billion.
State share: $12.9 billion
Federal share: $21.2 billion
Number of low-income, elderly and disabled Californians covered: 6.6 million
Average spent yearly per person in 2000: $2,068
National average: $3,762
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Schwarzenegger's first-year savings goal: $16.7 million ($12 million state savings).
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Five-year savings goal: $254 million ($142 million in state savings).
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Administration's Medi-Cal "redesign" proposals. All must pass Legislature to take effect:
- Move 800,000 more people into state's managed care networks, including 262,000 adults and children in El Dorado, Imperial, Kings, Lake, Madera, Marin, Mendocino, Merced, San Benito, San Luis Obispo, Sonoma, Placer and Ventura counties. More than 550,000 senior citizens and disabled residents would move to managed care in all counties where it is available.
- Add $1,000 annual cap on dental benefits for 3 million people. (Approximately 100,000 people exceeded $1,000 last year.) Estimated 2008 state savings: $26.3 million.
- Charge monthly premiums for 550,000 residents with incomes above 100 percent of federal poverty level: $4 per child and $10 per adult to family maximum of $27 to help pay for medical care. Example: Mother and two children with monthly income of $1,306 would pay $18 monthly. Among seniors and disabled, affects singles with monthly incomes of $805 and couples earning more than $1,422 monthly. Administration estimates approximately 100,000 people will not pay and be dropped from the program. Estimated 2008 savings: $22 million.
- New deal with the federal government to pay more costs of 24 public hospitals that provide care to the poor. Administration also proposes fewer overnight stays for Medi-Cal patients and more outpatient care for those enrolled in managed care plans. Estimated savings: being negotiated.
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Opponents argue:
- Hundreds of thousands of people will receive less care.
- Public hospitals and counties may end up with more of the unpaid bills and collapse.
- Seniors and the disabled may be forced to find new doctors after years of familiarity.
- Premiums are too high for poor, working families already struggling with high rents, old cars.
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Sources: California Department of Health Services, California Budget Project, Health Access, California Medical Association.
I have a novel idea, give out state scholarships for medical school, and make the recipients pay back by free medical care for the poor. Cut off payments for non-citizens, or back charge the govt of origin. NO dental care on my dime.
There is a very strong correlation between one's life style choices, one's health, and one's economic status.
I used to work in risk management for an HMO and there were enormous claims from people not buckling up their children and having them become human missiles during a collision. Those claims would often go over $1 Million.
There are the obese who go on to get diabetes and cardiovascular disease. Don't get me started on smokers.
I worked a stint in the dental division. It was not uncommon to replace all of child's teeth because their parents would put them to bed with a bottle of milk or Sunny Delight.
I resent my income being taken from me to pay for the less intelligent among us. Sorry. If they had to pay for their fair shake, they may end up making better decisions.
Where did anyone get the idea that anyone should be entitled to health care?
As far as i'm concerned, if you can't pay for it you shouldn't get it.
A better idea is to make people pay for their own health care. I'd be willing to give everyone $2,000 tax free for health care (and a subsidy of that size to the poorest) each year, and let them shop for their own health care.
That way, everyone could buy a catastrophic ins. policy and pay for routine care, and we'd be done with it.
All perfectly reasonable expectations.
These modest amounts need to be withheld from welfare/assistance/child support payments if necessary. "I can't afford it" is a crock. Of course, if they can get the courts to force me to pay, they'd rather I did so.
You mean like free breast reduction surgery for male prisoners? Well, it may be a joke, but it's not funny.
(Denny Crane: "Sometimes you can only look for answers from God and failing that... and Fox News".)
I'd rather he addressed the rising cost for everyone. Curbing the cost for the poor is usually code for raising the cost for everyone else.
I think it's extremely funny if the cause is excessive dubie smokin!!! (which is the leading cause of oversized male breasts!)
Sounds like more of that "Compassionate Conservatism" BS, to me! I'm suffering from compassion fatigue!! Why can't we simply have "Considerate Conservatism" where one considers all the BS to be actual BS and blows up the BS boxes like one says one is going to do??? Why???
Just ship the illegals back to Mexico and the problem will be solved.
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