ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Saturday, January 6, 1996 TAG: 9601100023
SECTION: EDITORIAL PAGE: A-7 EDITION: METRO
MEDICARE, with its politically active and influential constituency, has been an easy button to push for Democrats seeking political mileage by demagoging and obscuring the issue of entitlement spending growth. The fate of Medicaid, on the other hand, boils the entitlement issue down to its barest essentials.
Will America's poor now covered by Medicaid - the elderly, disabled, pregnant women and children - continue to be entitled to it, no matter how their numbers swell?
Or will the federal government, while shifting the burden onto states, free them to set their own eligibility requirements and standards of care, with a fixed amount of assistance from Washington?
The feds now pay at least half the cost of Medicaid. States pick up the balance, and agree to provide basic care to those eligible who apply. If the numbers of eligible go up - say, during a recession - so does spending.
Republicans favor block grants to states as a way to cap this federal expenditure and help balance the budget. This is not simple mean-spiritedness. The current system, if allowed to go on as it has, is unsustainable. Not long from now, it would bust the budget.
On the other hand, we are a nation in part because we share a commitment to the common good. As an affluent society, we shouldn't tolerate poor children and the elderly suffering and dying for want of medical care.
Some means need to be found for preserving the entitlement, therefore, while giving states more authority over administering Medicaid - flexibly, as they see fit.
President Clinton has proposed a compromise: Cap federal aid per recipient, to slow spending growth and discourage waste in the state programs, but still allow federal assistance to vary with demand. This is a reasonable starting point for change.
But further change will be needed. It ought to come not just as a budget-balancing measure, but as part of general reform in the delivery and financing of health care. (Too many Medicaid patients now, for example, get their primary care in expensive hospital settings.) And it should be understood that, whatever is decided, Medicaid changes will affect not just the poor but the middle classes, in ways many Americans may not have considered.
Further savings can be realized by closing remaining loopholes that allow some of the wealthy elderly to hide assets and get on Medicaid, leaving the government to foot huge tabs for long-term care that they could pay themselves. But closing every loophole won't fix the program.
Sixty percent of nursing-home residents are on Medicaid. One-third of Medicaid's $154 billion budget in 1995 was spent on them. Many of the elderly poor in nursing homes used to be neither rich nor poor, but middle class. They started out paying their way but, at an annual cost of $30,000 to $50,000, have seen their life's savings drained.
Your average, hard-working Mom and Dad. Or, someday perhaps, you.
It is not enough to talk glibly of personal responsibility and the need for families to take care of their own. Such talk translates into a provision allowing states, under the GOP block grant program, to require adult children earning more than the median income of $31,000 per household to pay for their parents' nursing-home care.
So, after parents' savings are wiped out, their adult children's can be drained. And when that is gone, the children can face their own old age in poverty. Fiddle-dee-dee. Worry about that tomorrow.
LENGTH: Medium: 65 linesby CNB