“The situation is critical,” said New York State Senator Martin Golden in response to a question about the New York senate’s decision to reduce Medicaid spending. “We want to save the state from going bankrupt. The program already takes up a lion’s share of our budget, and in the coming decade spending is predicted to double. However, we are trying to save as many of the medical services for its recipients as possible.”
On Dec. 16, state Sen. Majority leader Joseph Bruno (R-Brunswick), announced plans to drastically reduce Medicaid spending, seriously worrying low-income, elderly and handicapped recipients. Until recently, this group considered themselves shielded from the budget cut battle. Now, they are scrambling to predict where the cuts will be made and how they will be affected. Will some categories of Medicaid recipients be excluded? Will medical services that are now covered—like dental and eye exams—be cut? Maybe ambulance services will be slashed and patients will be forced to travel to medical facilities on foot? Or will doctor’s visits and prescriptions require additional payments? Will “nursing centers,” easing the misery of many elderly and sick people, be closed as well?
In the past, Medicaid, financed by federal and state coffers, was one of the few safe islands in the midst of the turbulent sea of social programs; it was a pillar of the American social welfare system that no one would touch, no matter the circumstance. The tragedy of Sept. 11, the economic recession, the war in Afghanistan, and then the war in Iraq, have even forced government leaders to re-examine their “sacred cows,” namely, Medicaid, Medicare and Social Security—Medicaid relies heavily on federal funds. President Bush proposed to Congress a plan to refashion these programs, which experts called the most radical proposed changes since their inception. Meanwhile, the federal government has given the states new authority in regulating these programs.
In New York, the picture is especially worrisome. Here, Medicaid eats up nearly half of the budget ($42 billion per year) and the average annual expenditure for each of the roughly three and a half million recipients is $7,646. (The national average is almost half that at $3,936.) In the past five years, Medicaid spending in the Empire State has grown by $12 billion (a 40 percent increase) and is expected to increase further at an alarming rate. Local authorities grew anxious—New York is the only state where counties cover a quarter of all Medicaid costs—and began pressuring Albany, complaining that the rising costs of health care, and correspondingly Medicaid, strains local budgets that are already stretched thin.
The growing cost of Medicaid is partly attributable to fraudulent and superfluous claims, ranging from ambulance transport for fully mobile patients who live footsteps from medical offices, to the extravagant parties thrown at “nursing centers.” Some doctors also squander Medicaid funds by scheduling unnecessary appointments and prescribing medications for recipients who then give them to family members, friends and neighbors. I was told of a certain woman who sent Medicaid prescriptions to her entire family ... in Russia.
Last year, Governor Pataki proposed several options for reducing Medicaid spending—the majority of which stalled in the legislature. And here we are with a new round of debates. From an initiative proposed by Bruno, the Senate Task Force on Medicaid Reform—established in June—decided that Medicaid spending should be cut by $2.5 billion in the next five years. New York State would save $1.6 billion, and local counties would save $900 million. The savings would allow for the expansion of the popular program, Family Health Plus, created for poor working families.
As noted in the New York Times, county leaders asked New York State to pick up three categories of Medicaid beneficiaries: the elderly, handicapped, and the blind. These constitute a third of all Medicaid recipients, but it is they who take up the lion’s share of expenses.
Pataki will surely propose his own version to reduce spending. In response to the Forward’s questions on Medicaid, the governor answered that it is premature to state anything concretely—serious debates and pitched battles still await the state legislature.
Golden, who, incidentally, is joining the Senate Task Force on Medicaid Reform, was more frank. “We won’t just save funds, but also give the elderly an opportunity to live out their last years with dignity in their own homes, not specialized institutions. They should not be afraid of losing the medical care and services they’re accustomed to; on the contrary, they will be better served and cared for in their homes. Another benefit is that elderly people will no longer need to hide their small savings that have prevented them from admittance to nursing homes. The sick and elderly should know that in either case they will receive quality care.”
To our question about the fight against Medicaid abusers, Golden resoundingly answered, “Currently, the crooks are getting away with taking advantage of the system. We will no longer tolerate them. They will bear full legal responsibility for their fraud. I think the prospect of spending a large part of their life behind bars will sober up the offenders.”
The Senate Task Force on Medicaid Reform consists largely of Republicans, but in Golden’s own words, it will take into account the views and opinions of the Democratic assembly members. This is significant, as among the Democrats—along with the leftist populist whose rallying cry is “Hands Off Medicaid”—there are those who will watch that the baby does not get thrown out with the bathwater.
Cuts in Medicaid spending should not put the health of recipients at risk, and the fight against fraud should not grow into a fight against the program itself. After all, for decades, Medicaid has nurtured the health and saved the lives of millions.
This article was written as part of the Ethnic Press Fellowship of the Independent Press Association-New York.
