MICHELE NORRIS, host:
From NPR News, this is ALL THINGS CONSIDERED and I'm Michele Norris.
ROBERT SIEGEL, host:
And I'm Robert Siegel. This week the House of Representatives is scheduled to vote on a bill that would reduce the federal deficit by an estimated 39 billion dollars over the next five years. The largest single set of reductions would affect health programs for the poor and poor children in particular. NPR's Julie Rovner has the story.
JULIE ROVNER reporting:
The House originally voted on the bill last December at around five a.m. just hours after it emerged from a closed-door conference committee. Senate democrats however exploited a technicality to get the bill sent back to the House, which had already adjourned for the year. The unexpected delay has given advocates an unusual opportunity to analyze the bill before the final vote. And Cindy Mann, a research professor at Georgetown University says they now know what those middle of the night negotiations produced.
Ms. CINDY MANN (Georgetown University): Some big winners and some big losers and the big winners were consistently the powerful interests represented by some of the provider organizations. The losers were consistently the low-income Medicaid beneficiaries.
ROVNER: For example, negotiators cancelled billions of dollars of cuts aimed at drug makers and health insurers. Those had been included in the original Senate bill. But lawmakers still had to meet their budget targets, says Mann, so they cut instead from beneficiaries of the Medicaid and State Children's Health Insurance Program. She says those cuts would have far reaching effect.
Ms. MANN: The changes would make it harder for some children to enroll in the program. They would make the program more fragmented. They would cause children to lose out on certain benefits that are now covered by the program.
ROVNER: In a final estimate produced just last week, the Congressional Budget Office says that more than three billion dollars in Medicaid savings would come at the expense of beneficiaries, much of it from reducing services and enrollment. Advocates like Mann are particularly upset about one piece of the bill that appears to allow states to offer less coverage to poor children than is currently mandated by federal law.
Ms. MANN: We never saw this provision before it emerged after the middle of night negotiations. It was not debated in the House; it was not debated in the Senate. Nobody saw this language. We still don't know exactly what it means.
ROVNER: What is clear is that states could offer benchmark plans that cover less than is currently required. Then they could offer separate as yet unspecified additional coverage for poor children to meet federal minimums. Georgia Republican Congressman Nathan Deal who helped negotiate the package says the bill would not in fact eliminate any current protections.
Representative NATHAN DEAL (Republican, Georgia): And we believe that statute in the reform that we have made is clear that for children under 19, any state that adopts a benchmark type approach would still be required to cover those children under those provisions.
ROVNER: Deal also says the Medicaid cuts are more than justified.
Representative DEAL: It is the kind of thing, as the name implies, is a deficit reduction act and people want us to reduce the deficit. We believe that Medicaid is, as the Governors have said, unsustainable over the long haul and these are the kind of reforms that if we don't make them will make the program unsustainable for states.
ROVNER: Deal also says that even if the law does somehow reduce required services he doubts states will cut care to poor children. Florida Republican Governor Jeb Bush, who was in Washington last week to talk about his state's Medicaid overhaul, agreed.
Governor JEB BUSH (Republican, Florida): I've heard that somehow if there's reforms in Medicaid that all the states will race downward. The record shows the opposite. The record shows that by and large, particularly in good times there has been an interest in expanding benefits or expanding beneficiaries in the Medicaid program.
ROVNER: On the other hand, Governor Bush's program would actually cap Medicaid spending for some beneficiaries, leaving it to health care providers to absorb the loss if patients need more care than the state is willing to underwrite. Meanwhile, children's advocacy groups are being joined by advocates for the elderly in fighting the federal budget bill. That's because it would also make it more difficult for senior's to qualify for Medicaid nursing home care. The House vote, currently set for Wednesday, is expected to be close. Julie Rovner, NPR News, Washington.
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