RENEE MONTAGNE, host:
Both the Bush administration and Congress say they want to help hurricane victims get health care, but they can't seem to agree on how. In an effort to head off a bill in the Senate it doesn't like, the White House says it can get the help that's needed using administrative power. But experts say the administration lacks the legal authority to do what it's proposing. NPR's Julie Rovner reports.
JULIE ROVNER reporting:
What's complicated about providing health care to hurricane victims is the fact that funding for the main health insurance program for the poor, Medicaid, is shared between the states and the federal government. That means if a storm victim from Louisiana is living in a shelter in Texas, Texas would be expected to pay the state's share of Medicaid for that Louisiana resident. President Bush has vowed that the federal government won't make those host states pay for caring for other states' evacuees, as White House spokesman Scott McClellan explained at yesterday's briefing.
Mr. SCOTT McCLELLAN (White House Spokesman): We're making sure that states are compensated for the care that they're providing to these people who were covered under Medicaid. That's something that the president has been committed to. We've already issued waivers to cut through the red tape in Medicaid and get people the care they depend upon.
ROVNER: Indeed, the administration has so far issued those waivers to a half dozen states promising them payment for Medicaid costs for storm victims. Because only Congress can actually change Medicaid reimbursement, the administration has required Louisiana, Mississippi and Alabama to sign documents promising to pay for their displaced residents at some point. But Sara Rosenbaum, a health lawyer and Medicaid expert who chairs the Department of Health Policy at George Washington University, says that oversteps even the vast powers of the secretary of Health and Human Services.
Ms. SARA ROSENBAUM (Attorney and Medicaid Expert, George Washington University): The notion that you can simply start moving national Medicaid money around, loan one state the full freights and then try and come up with agreements to collect back from another state seems to me just outside the realm of anything that has ever been attempted. And I can find no authority that would allow this.
ROVNER: Mark McClellan, older brother of the White House spokesman, heads the Medicare and Medicaid programs. He says what the administration is doing is perfectly legal.
Mr. MARK McCLELLAN (Heads Medicare and Medicaid Programs): We have authority under the Medicaid program to set up waivers to assist people with their health care costs and to pay for uncompensated care. We also have additional administrative authorities to help with disaster relief. By putting those two together, we can provide full support for the states that are hosting evacuees from Hurricanes Katrina and Rita.
ROVNER: But backers of the Senate bill say that's not nearly enough. Their legislation would temporarily extend Medicaid to all poor people displaced by the hurricane. The administration's proposal only envisions payment for those who would have been eligible for Medicaid in their home states, like pregnant women, children and the elderly. At a Senate Finance Committee hearing Wednesday, Democratic Senator Blanche Lincoln of Arkansas said the federal government has an obligation to go further; for example, to help a woman who floated on a refrigerator in flooded New Orleans for three days.
Senator BLANCHE LINCOLN (Democrat, Arkansas): She finally made it to Baton Rouge. She got there thinking that her nation would provide her a safety net of health care. She was diabetic. She needed immediate care, and do you know what she was told? That as a childless woman, she was a categorical restriction and could not get the health care she needed.
ROVNER: Meanwhile, as Congress and the administration bicker, hurricane victims are still waiting. A survey from Louisiana last week found one of every five people seeking health coverage were being turned away at the outset, and a third of all completed Medicaid applications were being rejected. Julie Rovner, NPR News, Washington.