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FreeRepublic , LLC PO BOX 9771 FRESNO, CA 93794
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Posted on 01/18/2003 3:25:01 AM PST by sarcasm
Eric Dean of Clarence Center faced a dilemma: how to pay for college studies while providing health coverage for himself, his wife and his newborn son. A new Medicaid program provided the answer. Valerie Daniels suffered a disabling stroke at age 40, tossing her from the work force and leaving her no way to pay for the therapy she desperately needed.
That same new Medicaid program - Family Health Plus - came to her aid. These expanded Medicaid services are now highlighted in the upbeat television commercials promoting Gov. George E. Pataki and New York State. But what the commercials don't tell you is the cost that every taxpayer bears for these benefits. Medicaid, and its expansion, is the single biggest reason all county taxpayers in the state will either see their taxes go up, their services slashed, or their county's reserve funds drained this year. The state Medicaid bill has swollen to $36 billion, with overall costs equal to those of California and Texas combined. And it's far more than just some cut-rate health care program for the poor. The state program provides long-term care for seniors, health benefits to more than a million under age 21, assistance for the disabled, and coverage for low-income working families, as well as those on welfare. It covers everything from eyeglasses and anti-smoking medication to orthopedic shoes. With expanded Medicaid eligibility and the sinking economy after Sept. 11, 2001, Erie County alone saw a 9.5 percent increase in the number of people signing up for Medicaid-funded programs last year, bringing the total to 122,000, the highest number in six years. In short, Medicaid is one of the state's biggest financial problems in the new year. Some believe county leaders are in the best position to find a solution because they manage the program locally. They also have the political clout to make Albany take notice. "If there's ever been a legitimate opportunity to get reform and financial relief, it's now," said Erie County Executive Joel A. Giambra, who met with other county leaders about the Medicaid issue last week. "Every effort is being made to put a full court press on that has never been seen in Albany before." Root of the problem In the 1960s, Gov. Nelson Rockefeller laid the blueprint for a state Medicaid program that would provide the greatest level of coverage for the greatest number of people. New York picked up all of Medicaid's optional services - including full prescription drug coverage, vision and dental care - making it one of the most comprehensive and expensive health care programs adopted by any state. The federal government paid half the cost, but the state also required that counties pick up as much as a fourth of the remaining costs - up to half the nonfederal share. Most other states require no county contribution. "Albany gets all the political glory for mandating souped-up Medicaid coverage," said Matthew Maguire, spokesman for the Business Council of New York State. "But a lot of times, locally elected officials have to pay the political consequences." When the state expanded the Health Care Reform Act of 2000, it dramatically expanded Medicaid coverage for the uninsured by raising income eligibility limits, bringing the state closer to providing universal health coverage. In Erie County, the number of people signing up for Medicaid-funded programs jumped by 12,000 last year. "If there's one thing that's changed over the years, it's coverage for people who are not the poorest of the poor," said Deborah Merrifield, Erie County social services commissioner. Many believe that's a good thing. Helping those in need Recent college graduates living in Clarence Center, Kellie unexpectedly became pregnant and gave birth to a son last year. Since Eric had returned to college to become a physician's assistant and Kellie was bringing in the only income by waitressing a few days a week, the couple had no health insurance and they weren't poor enough to qualify for traditional Medicaid. Eric, a diabetic, would have had to take out additional loans for health care coverage if it weren't for Family Health Plus. Under this new program, the family doesn't have to shell out an additional $200 a month for needles, insulin and test strips. For Daniels, a Buffalo resident, the program has been a lifeline to improvement. Daniels was only 40 when she suffered a stroke in 2000 that affected her speech and left her right side paralyzed. Until then, she drew a steady income as a day care provider. She drew disability income after her stroke that made her ineligible for Medicaid, even though she was no longer able to work. Uninsured for six months, she went without therapy, and her family had to pay $70 a month for medication. "It was very costly," said her son, 22-year-old Ahmad McEntire, who now takes care of his mother and her two adopted nephews. "It's just us, you know." Family Health Plus now covers his mother, who gets in-home therapy twice a week and is improving. Her nephews also receive Medicaid assistance. That kind of expanded Medicaid eligibility comes with a cost, and counties are paying a hefty share while juggling other debts associated with the depressed economy. The price counties pay For the first time in Erie County, every penny raised in property taxes goes to pay for Medicaid. New tax bills being sent to all county property owners have been redesigned to reflect that. "We don't have a county tax - we have a Medicaid tax," said Budget Director Joseph Passafiume. At least four other counties are in the same position, said Ken Crannell, a spokesman for the New York State Association of Counties. "Medicaid is a monster," Crannell said. "It's devouring all available resources." While county leaders have worked to trim 2003 budgets - freezing or eliminating thousands of vacant jobs - they look to 2004 with even greater dread. In county budgets adopted for this calendar year, tactics range from efforts to raise sales taxes by 1 percent in Niagara and Westchester to a 21 percent property tax hike in Chautauqua. Counties killed street maintenance and youth programs, and drained reserves. Erie County covered a $35 million deficit primarily with reserve funds and is relying on a sale of tax liens to the state in April to replenish accounts. No one wants to see another year like this one. "In five or six years, we'll be an insurance company, and that's about it," said Chautauqua County Executive Mark W. Thomas of rising Medicaid costs. County leaders intend to impress Albany with their message of impending doom, but they don't all champion the same solutions. In addition, New York's fiscal crisis makes it a bad time for counties to insist that the state pick up more county expenses. The state already pays 40 percent of Medicaid's long-term care costs for the elderly. More than a third of the state Medicaid budget goes to pay for this alone. This coverage benefits people such as 78-year-old Agnes Schmidt. In 2000 and 2001, Schmidt suffered a series of falls that fractured her hip, back and skull. Her son and daughter-in-law did their best to help, visiting her at home and hiring health aides, but they couldn't keep her injuries at bay. "I needed to keep her safe," Michelle Schmidt said with a sigh. She and her husband finally decided to place Agnes in Buffalo's Ridgeview Manor nursing home. They sold Agnes' home to cover the $7,000 monthly bill, but eventually that money ran out. Agnes went on Medicaid. "If we didn't have it, we probably would have had to bring her home, and I would have had to leave my job because she requires care 24 hours a day," Michelle Schmidt said. "Physically and emotionally, I don't know how long I could have kept it up." Giambra is one of many county officials who believes the state can't be asked to take on the counties' Medicaid burden without providing the state some way to cover these new debts. He and others have floated a number of proposals that fall into one of two categories: changing the formula for who pays the Medicaid bill, or reforming/reducing Medicaid costs and coverage overall. For instance: • Giambra has suggested the state raise the sales tax 1 percentage point and take over the counties' Medicaid burden while providing a separate, special relief package for New York City. In exchange, counties would use the money spent on Medicaid to lower local taxes. • Assembly Majority Leader Paul A. Tokasz of Cheektowaga says if the state takes over local Medicaid costs, the counties should give the state a 1 percentage point share of the sales taxes they already collect while the state considers other revenue sources, such as raising income taxes. Giambra also backs this plan. • The state Association of Counties recommends a cap on Medicaid, essentially saying that in future years, the counties would continue to pay the same amount toward Medicaid that they pay now, but the state would assume any future costs. State Sen. Mary Lou Rath, R-Amherst, has already pledged to reintroduce a state bill that would cap county Medicaid expenses. "We are the Cadillac of all Medicaid systems," Rath said, "and we have to take a look at that." Under each of these proposals, state taxes would likely rise, but Giambra said county property taxes cannot afford to grow. "The local property taxes in New York State are 64 percent above the national average," he said. "Something has to be done to reduce that." Push for reform Albany Comptroller Mike Connors stands among those who believe shifting the financial Medicaid burden isn't enough. "You aren't going to solve the problem with Medicaid by switching where you get the money from," he said. "The problem is with the system itself." He and others have suggested a Medicaid waiver or voucher program. Counties would be allowed to opt out of the state Medicaid program by transfering Medicaid recipients to the county's own health insurance plans. These would be the same plans that county employees are eligible for and would cost about half as much per person, he said. The downside is that such a plan would reduce current Medicaid benefits for the poor. In addition, this wholesale overhaul would be complicated to implement. Other county leaders, including Erie's, are recommending smaller reforms of particular aspects of Medicaid coverage. Given the state budget crisis, many Albany lawmakers and lobbyists believe the governor will be forced to curb Medicaid spending, particularly since Pataki clipped Medicaid costs to make ends meet when he first entered office. That will require throwing people off the program, cutting benefits, or reducing payments to health providers, they said. Pataki is far from alone in making these tough decisions as a state leader. A study just released by the Kaiser Commission on Medicaid and the Uninsured shows that 40 states are looking at shortfalls in their Medicaid budgets, and nearly all plan to cut Medicaid spending and seek federal relief. E.J. McMahon, a senior fellow with the Manhattan Institute, a conservative think tank, said since counties locally administer Medicaid, county leaders are in the best position to know how to cut costs in a way that hurts the fewest people.
It's certainly good for Eric Dean and his wife, Kellie.
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FreeRepublic , LLC PO BOX 9771 FRESNO, CA 93794
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Don't you hate it? You're walking along a road, minding your own business and, wham, you unexpectedly become pregnant.
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