||[Feb. 3rd, 2006|04:23 pm]
Budget to Hurt Poor People on Medicaid, Report Says |
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By ROBERT PEAR
Published: January 30, 2006
WASHINGTON, Jan. 29 — Millions of low-income people would have to pay more for health care under a bill worked out by Congress, and some of them would forgo care or drop out of Medicaid because of the higher co-payments and premiums, the Congressional Budget Office says in a new report.
The Senate has already approved the measure, the first major effort to rein in federal benefit programs in eight years, and the House is expected to vote Wednesday, clearing the bill for President Bush.
In his State of the Union address on Tuesday, Mr. Bush plans to recommend a variety of steps to help people obtain health insurance and cope with rising health costs. But the bill, the Deficit Reduction Act, written by Congress over the last year with support from the White House, could reduce coverage and increase the number of uninsured, the budget office said.
Over all, the bill is estimated to save $38.8 billion in the next five years and $99.3 billion from 2006 to 2015, with cuts in student loans, crop subsidies and many other programs, the budget office said. Medicaid and Medicare account for half of the savings, 27 percent and 23 percent over 10 years.
The report gives Democrats new ammunition to attack the bill. But they appear unlikely to defeat it, since the House approved a nearly identical version of the legislation by a vote of 212 to 206 on Dec. 19.
Senator Charles E. Grassley, Republican of Iowa, said the bill was needed because Medicaid had been growing at an unsustainable rate.
But Senator Jeff Bingaman, Democrat of New Mexico, said the budget office report confirmed that the bill would "cut access to care for some of our most vulnerable citizens."
The bill gives states sweeping new authority to charge premiums and co-payments under Medicaid.
"In response to the new premiums, some beneficiaries would not apply for Medicaid, would leave the program or would become ineligible due to nonpayment," the Congressional Budget Office said in its report, completed Friday night. "C.B.O. estimates that about 45,000 enrollees would lose coverage in fiscal year 2010 and that 65,000 would lose coverage in fiscal year 2015 because of the imposition of premiums. About 60 percent of those losing coverage would be children."
The budget office predicted that 13 million low-income people, about a fifth of Medicaid recipients, would face new or higher co-payments for medical services like doctor's visits and hospital care.
It said that by 2010 about 13 million low-income people would have to pay more for prescription drugs, and that this number would rise to 20 million by 2015.
"About one-third of those affected would be children, and almost half would be individuals with income below the poverty level," the report said in addressing co-payments for prescription drugs.
Under the bill, states could end Medicaid coverage for people who failed to pay premiums for 60 days or more. Doctors and hospitals could deny services to Medicaid beneficiaries who did not make the required co-payments.
The budget office said the new co-payments would save money by reducing the use of medical services.
"About 80 percent of the savings from higher cost-sharing would be due to decreased use of services," the report said.
The official estimates take into account the fact that "savings from the reduced use of certain services could be partly offset by higher spending in other areas, such as emergency room visits."
After talking to federal and state officials and reviewing Medicaid data, analysts at the Congressional Budget Office predicted that states would charge premiums to 1.3 million low-income people and cut benefits for 1.6 million people. Most of the cuts would affect dental, vision and mental health services, it said.
The bill also makes it more difficult for people to qualify for Medicaid coverage of nursing home care by transferring assets to children or other relatives for less than fair market value.
This provision would delay Medicaid eligibility for 120,000 people, or about 15 percent of the new recipients of Medicaid nursing home benefits each year, the budget office said.
Under another provision of the bill, Medicaid would deny coverage of nursing home care to any person with home equity exceeding $500,000. States could increase the ceiling to $750,000. About 2,000 people a year would be denied nursing home benefits because of the cap on home equity, the budget office said.
Taken together, these provisions, requiring people to use more of their own assets to pay for nursing home care, are expected to save the federal government $6.4 billion over 10 years.
The budget office estimated that 35,000 Medicaid recipients would lose coverage because of new, more stringent requirements for them to prove United States citizenship. Most of those losing coverage would be illegal immigrants, but some would be citizens unable to supply the necessary documents, the report said.
Other provisions of the bill would establish stricter work requirements for welfare recipients and cut federal payments to the states for enforcing child support orders. The cut would save the federal government $4.1 billion over 10 years, but child support collections would decline as a result, the budget office said.