Bush, Congress Split on Medicaid Measure

Congress is working to extend Medicaid coverage for victims of Hurricane Katrina, but Bush administration officials are working against the measure, promising instead health care for evacuees and federal help for the states.

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Now Hurricane Katrina helped to form an unlikely alliance in the US Senate. A bipartisan group there has been working to expand the Medicaid health program for the poor so that it covers many of the storm survivors. President Bush has also promised health care for evacuees and federal help for the states, but officials in his administration are actively working against this Senate bill. NPR's Julie Rovner explains the dispute.

JULIE ROVNER reporting:

In unveiling the bill last week, Iowa Republican Charles Grassley said he hoped Congress would act within days to expand Medicaid to all hurricane survivors with incomes below the federal poverty line.

Senator CHARLES GRASSLEY (Republican, Iowa): We're talking about people who have lost everything. We're talking about the most vulnerable citizens suffering: low-income families, the infirm, the displaced, the disabled. We need to help these people who are in crisis and that's what this package is all about.

ROVNER: The bill has drawn the unanimous support of both Democrats and Republicans on the finance committee Grassley chairs. It would let evacuees enroll in Medicaid in their temporary home states for up to 10 months with the federal government picking up 100 percent of the cost normally shared with states. The federal government would also underwrite all Medicaid costs for Louisiana, Mississippi and storm-struck counties of Alabama. Montana Democrat Max Baucus says using Medicaid, which already covers more than 53 million Americans, is the most efficient way to get health care to the storm survivors.

Senator MAX BAUCUS (Democrat, Montana): In this situation, Medicaid can provide the relief that's necessary. We don't have to invent a new program. It's already there.

ROVNER: But that's not how the Bush administration sees it. Last week, the Department of Health and Human Services cut a separate deal with Texas. The waiver of normal Medicaid rules would let Texas sign up evacuees for Medicaid but only those who would normally be eligible for the program, like pregnant women, children and poor seniors on Medicare. For everyone else, the administration would provide a fund to help pay doctors or hospitals who treat patients without insurance. Medicare and Medicaid Administrator Mark McClellan says the waivers are all that states require.

Mr. MARK McCLELLAN (Administrator, Medicare and Medicaid): The waivers are meeting the needs of evacuees to pay for getting the care that they need. They're meeting the needs of paying the health-care providers that are coming together in new ways to deliver it. And they're meeting the needs of the states that have put in their own money and time and effort to make the states whole in this process.

ROVNER: But that's not how outside Medicaid experts see it.

Mr. TIM WESTMORELAND: The Bush proposal is not nearly as helpful to the evacuees, to the medical professionals and to the states as the bipartisan legislation.

ROVNER: Tim Westmoreland ran the Medicaid program in the Clinton administration. He says that the Bush plan leaves out thousands of childless adults who may desperately need medical care, and at the same time, he says...

Mr. WESTMORELAND: For the doctors, the clinics, the hospitals who are taking care of the evacuees, the Bush proposal provides no certainty that they're ever going to get paid and no clarity of what benefits are covered and which ones aren't.

ROVNER: Medicare and Medicaid Chief Mark McClellan, however, says it's the legislation that would prove cumbersome.

Mr. McCLELLAN: I don't think it's necessary or helpful or timely to try to set up new federal systems to deal with this immediate problem.

ROVNER: One reason the administration has taken such a different approach than the Senate says Westmoreland, is that that's all it can do. It will take an act of Congress to actually increase state funding for Medicaid, but another reason is that many conservatives are privately shying away from the idea of expanding Medicaid even temporarily.

Mr. WESTMORELAND: I suppose it's possible that people may be uncomfortable with the precedent of helping all poor people instead of just some people who fit into a pigeonhole. I don't see that that's going all as far as you can to help the Katrina survivors.

ROVNER: But while some Democrats say that Republicans are using hurricane victims as guinea pigs for unproven conservative proposals, Republicans say that Democrats are using the crisis to force additional spending Congress would otherwise be unlikely to approve. Julie Rovner, NPR News, Washington.

INSKEEP: This is MORNING EDITION from NPR News.

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