Medicaid said near collapse in nation
(2/25/02 Arkansas Democrat Gazette) By Paul Barton

WASHINGTON -- Joined by Arkansas' Mike Huckabee, the nation's governors spent Sunday pleading to Congress and the Bush administration to help them with Medicaid before the program drains funds from education and other key state services.

Medicaid, the nearly 40-year-old federal-state health insurance program for the poor and the disabled, seemed to easily overshadow all other issues at the winter meeting of the National Governors' Association. The program costs close to $200 billion a year in state and federal funds combined.

For Huckabee, who has been dogged by protests over changes to Medicaid programs in Arkansas, the governors' meeting showed that there is no escaping the issue.

Nationwide, demand for Medicaid services and rising health-care costs have created a funding crisis of historic proportions, governors said. In many states, it is now eating up 20 to 25 percent of budgets and consuming almost all of whatever growth in revenues states are seeing.

While Medicaid has been in crisis before, this time it's different, the governors said. "The perfect storm has formed," said Gov. Roy Barnes of Georgia, a Democrat, referring to an aging population and a recession that have combined to put unprecedented demands on Medicaid dollars.

At a news conference, Huckabee likened Medicaid to "the bobsled of government programs" and warned that governors can't keep it from crashing much longer. The governors spent a two-hour working lunch going over the latest nationwide Medicaid figures and projections. The governors plan to take their message to President Bush at a meeting today at the White House.

Huckabee and other governors, including Democrat Paul Patton of Kentucky and Republican John Engler of Michigan, the chairman of association, urged an immediate increase in federal matching funds and more flexibility for states in administering the money. Governors said added flexibility would give them more room to be creative in containing costs.

"It's a major crisis," said Kentucky's Patton. "Something needs to be done."

Said Dirk Kempthorne, Republican governor of Idaho, "everybody is in the same boat."

A plan to increase the federal matching share has been included in economic stimulus bills, but not one has passed both the House and the Senate.

Medicaid traditionally has been a lower-profile issue for Congress than Medicare, the government health-insurance program for the elderly. "It needs to be [higher-profile]," Huckabee said. The governors released Congressional Budget Office figures showing that Medicaid, in terms of the number of people served, has become bigger than Medicare. Medicaid is serving 44. 7 million compared to Medicare's 40 million. But just 7 million who are eligible for both Medicaid and Medicare are accounting for 30 percent of Medicaid's costs, the governors said.

Huckabee blamed health-care providers, such as doctors and hospitals, for feeding spending increases that have caused Medicaid to spiral out of control. The providers, he said, push for inclusion in the program of an ever-growing number of services.

"We want to meet the needs of the patient and the client rather than the demands of the providers," he said.

The head of the one of the state's provider groups said health-care professionals also focus on the needs of the patient. "From the hospital perspective, I would agree with him. That is the mission of hospitals and physicians, too, to meet the needs of the patient. With the millions of dollars of charity care that hospitals provide every year, I think that's pretty clear," said Jim Teeter of Little Rock, president and chief executive of the Arkansas Hospital Association.

Florida Gov. Jeb Bush, the brother of the president, said he wasn't coming to Washington looking for a major Medicaid handout. "Washington has budget issues as well," he said. "The issue ought to be taking advantage of this tougher time to be more creative in dealing with these issues," Bush said.

Meanwhile, Huckabee said welfare reform is the other of the "big gorillas" looming over the governors. Congress this year is scheduled to reauthorize the landmark 1996 reforms that instituted time-limited welfare benefits. The reforms required recipients to find work. The governors are expected to consider resolutions that will deal with nuances of the program, such as the definition of work and whether recipients should receive benefits beyond existing time limits, which range from two to five years, depending on the state. Huckabee said he wants assurance that the federal government will fully fund block grants under the Temporary Assistance for Needy Families program. The grants total $16. 5 billion a year. If funding is cut, as some conservative critics of the program have proposed, "our major concern is that we may create a whole new class of [welfare] cases," Huckabee said.

Governors including Florida's Bush also emphasized the need for stable funding. "Some degree of stability helps us with our budgets," he said.