Rendell warns of future Medicaid growth

HARRISBURG, Pa. - Gov. Ed Rendell said Monday he hopes to find money to soften some of his proposed Medicaid cuts, but warned that the program that provides health care for one in seven Pennsylvanians poses many future funding problems.

Growth in Medicaid, which serves 1.8 million poor and disabled health care, is projected to outstrip state tax revenue by $1 billion in each of the next five years, Rendell said.

To help rein in a similar funding gap this year, Rendell proposed $500 million cuts to Medicaid that he indicated Monday could be softened.

"There are some additional revenues, not a lot, certainly not enough to replenish all of the cuts," Rendell said.

Rendell spoke to reporters after meeting with legislative leaders on the state budget for the first time since he unveiled his proposal in February.

The fiscal year begins July 1, giving the Republican-controlled Legislature and the Democratic governor less than three weeks to begin serious discussions and deliver a budget on time.

Discussions are expected to be dominated by Medicaid, which is now the state's fastest-rising expense. Of Rendell's total $23.8 billion budget proposal, $4.5 billion, or nearly one-fifth, would go toward Medicaid.

The budget does not include any broad tax or fee increases, or the introduction of any major new programs, and it does not roll back eligibility standards for Medicaid. Under Rendell's plan, Medicaid would cover fewer hospitalizations and drug prescriptions while cutting reimbursements to hospitals, pharmaceutical companies and more.

Rendell's Medicaid cuts have received a cool reception in the Legislature, where Democrats are skittish about cutting services to the poor and disabled; Republicans say the cuts will damage the state's hospitals.

Instead, House Speaker John M. Perzel, R-Philadelphia, said after the meeting with Rendell that Republicans will look for ways to scale back the breadth of Medicaid coverage that he labeled as among the most generous in the country.

Revenue sources that could be tapped to fill in the Medicaid cuts include unused surplus revenue of well over $100 million and money currently booked for adultBasic, the state's health insurance program for low-income working adults.

I work for a certain State and am a contact person for Medicaid for children and for pregnant women.

I would like to see the following reforms Nationwide in the Medicaid program:
1- Parents with children on Medicaid or the CHIPs program pay a co-pay at the doctor, dentist, emergency room and pharmacy, just like people with "regular" insurance.
2- Establish a maximum payout for Medicaid and the CHIPs program at which time a deductible must be paid by the parents in regular monthly payments until paid in full. After the deductible is paid, Medicaid/CHIPs pays 90% and the family pays 10% up to a maximum amount to be determined. Then there's a higher deductible paid in monthly installments until paid at which time Medicaid/CHIPs then pays 80% and the family 20%. If a family refuses to pay their deductible, the State can garnish wages or if the parent(s) claim no income, can place them in a work program or in detention until they come to their senses.
3- Give more benefits to those who qualify for the CHIPs program (Children's Healthcare Initiative). Allow CHIPs to co-pay so that parents won't drop their health coverage to pick up the CHIPs program because it pays for dental and eye exams and has other coverage that many private and employer insurance companies do not pay. ALSO allow State Employees and Teachers (in States where they currently cannot obtain it) to be eligible for the CHIPs insurance for their children.
4- Monitor doctors' offices more closely. Case in point: A child with asthma who went to the doctor regularly for years was seen by a specialist for another problem and the specialist chastised the guardian for not having had the child's tonsils removed. The guardian had asked the original doctor many times about removing the child's tonsils but the original doctor said that was not necessary. NO, I guess not. He was easily making a couple thousand dollars a year from Medicaid if he kept the child "sick" and would lose that income once she was well. (Makes me wonder how many other children are treated with such disrespect and contempt by doctors who make their living on Medicaid.)
5- Cut back on the cash payment to persons on SSI. Give them Medicaid, but look at the entire family situation before giving them the full amount of SSI. There are too many people who live off of other people's SSI payments who would have to go to work if there was no SSI check coming into the home.
6- Give pregnant women a co-payment before Medicaid will pay the remainder of the costs of pregnancy and delivery. Let the happy parents be responsible for some of the cost of procreating. Single Mom with no husband or "sperm-donor"? Then she pays the entire deductible. It doesn't have to be that much -- $500 each for the first three babies and then $1000 each for additional children. Let the parents realize that having babies is a huge responsiblity and they might just want to put some deep thought into procreation before they do it.
7- Waive all fees for pregnant women who give their babies up for adoption and who do not try to reclaim the child. Reclamation makes the waiver null and void.
8- Women who choose to terminate their pregnancies mechanically must still pay the deductibles and the medical costs associated with the termination. Women who have a miscarriage are refunded a portion of their deductible if the miscarriage occurs before the second trimester.
9- Medicaid for Hospitals, Nursing Homes, Mental Health Homes, other Residential Treatment Facilities be monitored a lot more closely. Physicians who stick their head in patients' rooms and then charge Medicaid for an official medical visit should be heavily fined. Psychiatrists who briefly glance at medical notes from their employees and then charge Medicaid for an official consultation should be heavily fined.
10- Medicaid Families who have a smoker in the house be mandated to attend "stop smoking" clinics (at their own expense) until they quit smoking. Reason: children end up with a lot of medical problems that are directly linked to cigarette (cigar, pipe) smoke.

I think that's all for now.

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