Bush Meets Resistance on Medicaid Spending Plan

Members of Congress and President Bush are heading for another showdown over health care. This time it involves a series of regulations the administration says will save the Medicaid program billions of dollars. But the nation's governors and health care providers say it will unfairly pass costs to states and hurt patients.

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RENEE MONTAGNE, host:

Among the issues that the presidential candidates are arguing about is how best to fix the nation's healthcare system. They might get a chance, starting next year, but at the moment President Bush and Congress are locking horns over more incremental changes that will limit some care. At issue is the administration's effort to cut back the Medicaid Health Insurance program for the poor.

NPR's Julie Rovner has more.

JULIE ROVNER: The House today is expected to easily approve the bill that would block implementation of seven separate administration regulations affecting Medicaid. The rules cover everything from payments to hospitals to transportation for disabled schoolchildren.

Dennis Smith, the former head of Medicaid, told a House committee early this month that the regulations were needed to stop states from gaming the Medicaid program, whose costs are shared between the federal and state governments.

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Mr. DENNIS SMITH (Former head of Medicaid): Our objective is to ensure that federal Medicaid dollars are matching actual state payments for actual Medicaid services for actual Medicaid beneficiaries. Medicaid is already an open-ended federal commitment for Medicaid services to Medicaid recipients. It should not become a limitless account for state and local programs and agencies to draw federal funds for non-Medicaid purposes.

ROVNER: But the regulations have provoked a long and loud outcry from the nation's governors, health care providers, and those who care for low income patients. They say the rules simply go too far. That they would hurt people Medicaid is supposed to help.

Barbara Coulter Edwards heads the National Association of State Medicaid Directors.

Ms. BARBARA COULTER EDWARDS (National Association of State Medicaid Directors): A school nurse who works today to help a child enroll in the Medicaid program is not an abuse of the system. But under the school services regulations this legitimate activity would be prohibited from receiving Medicaid support.

ROVNER: She says the administration's regulations aren't really about Medicaid's fiscal integrity at all.

Ms. COULTER EDWARDS: They are about limiting the services that the federal government will share in funding through Medicaid.

ROVNER: Other health care providers warn that taking tens of billions of dollars out of the health care safety net could hurt more than just Medicaid patients. Angela Gardner is an emergency room doctor at the University of Texas at Galveston. She testified under oath before the House oversight committee last November about a recent shift she'd worked.

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Ms. ANGELA GARDNER (Emergency room doctor): And on my arrival, all 48 of my beds were full. We had 22 patients in the hallway. We had 14 patients in the waiting room. We had three ambulances unloading and two helicopters waiting to land.

ROVNER: That's pretty normal she said. Among her patients that night was a man she called Norman. She said he was brought in comatose by his mother from a town 250 miles away. He'd been waiting eight days for a hospital bed after having been diagnosed with a brain tumor. And when she left the next morning, he was still waiting for that bed.

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Ms. GARDNER: I do not know if Norman died, but I believe that he will die in that trauma bay. He will never see the inside of the hospital. And as you sit here and absorb the impact of this story, I'd like to let you know something. Norman is not indigent. Norman is a working man with health insurance. And the problem with the cuts to Medicaid that are being proposed is that it affects not only the indigent but everyone out there. This could happen to you. it could happen to someone that you love.

ROVNER: In fact, Gardner said later, Norman did finally get his surgery but died shortly thereafter.

Witnesses like Gardner have made it relatively easy for Republicans in Congress to break with the Bush administration. Alan Weil is with the National Academy for State Health Policy.

Mr. ALAN WEIL (National Academy for State Health Policy): You don't feel very caught in the middle when your constituents are speaking with a quite unanimous voice that these rules are going to be harmful.

ROVNER: During yesterday's brief House floor debate there was barely a mention of the president's veto threat on the bill. If the Senate follows the House's lead, this could become the second veto override of Mr. Bush's presidency.

Julie Rovner, NPR News, Washington.

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