Bad Law in Congress This Week: Call Now

by John S. James

Summary: We asked readers to call their U.S. Representative before the vote on February 1 to oppose a budget bill with huge Medicaid (Medical Assistance, Medi-Cal) cuts. Unfortunately the House passed the bill by a vote of 216-214.

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On Wednesday February 1 the U.S. House will vote on a budget reconciliation bill, including Medicaid "reform" that has lots of problems:

It will allow states to put huge copays on medicines for the poorest patients, often resulting in denial of care. In some states the copays could be over $100 for a bottle of Combivir, or for each day's stay in a hospital. Medicaid is by far the largest provider of HIV care. The clear intent of the changes is to save money by preventing poor people from getting essential medical care.
It will let pharmacies, clinics, and other organizations refuse medicines to patients who cannot pay the copay -- unlike Medicaid today. (The new MediCARE Part D also lets pharmacies refuse medicines due to lack of the copay, and the "dual eligibles" who had to switch to a Medicare plan on January 1 are already being denied medicines for this reason; the protection they had in the past is now gone. The new law would extend that to the many people on Medicaid who are not eligible for Medicare, and allow states to vastly increase copays for the poorest patients.)
It will give states "flexibility" that will let them discriminate against certain populations -- instead of offering uniform benefits to every qualified person in the state, as with Medicaid now.
It will make most people on Medicaid show a birth certificate or passport every time they are recertified, and new applicants will have to do so before they get care; persons on Medicare or SSI are exempt. Many elderly African Americans never had birth certificates because their births were not recorded -- and getting a U.S. passport without a birth certificate is difficult and arbitrary. There are no exceptions for illness or circumstances; if someone has Alzheimer's, or major depression, or is bedridden or otherwise unable to get the paperwork together, or lost their records in a disaster, too bad -- no Medicaid, and probably no medical care. The goal is to save money by denying care to the poor when they are sick, in order to avoid reducing the profits of pharmaceutical or insurance companies.
The bill has other major problems and will affect millions of people. For example, 28 million children will lose the current guarantee that states provide them with coverage for all medically necessary services; that will be replaced with new rules with ambiguities that have not been worked out. This provision, introduced in the conference report (which is supposed to iron out differences between bills from the two branches of Congress), did not appear in either the House or Senate bills, and was never debated by either. And most of the "savings" in the bill as a whole are expected to come from children losing medical coverage. For the first time, providers will be allowed to deny care to children because their families do not have the copays. (Source: Georgetown University Health Policy Institute, Center for Children and Families)

As we went to press, the Congressional Budget Office released a report with detailed estimates of the impacts on Medicaid of the budget bill. For example, 80% of the savings will come from denial of medical care. In 2010, 65,000 people will lose Medicaid coverage due to the premiums alone, and about 60% of them will be children. And each year, 120,000 new people will be denied nursing home coverage under Medicaid by one provision alone. For more information, see The New York Times January 30, "Budget to Hurt Poor People on Medicaid, Report Says," by Robert Pear.

What will be the public-health consequences of having thousands of people sick or dying at all times, due to treatable but untreated illnesses? What will be the moral consequences for our society?

Non-health consequences include billions of dollars cut from student loans, which will prevent many people from getting a college education.

This almost 800-page bill was voted at 3 a.m. just hours after it was printed, before House members had time to read it; it passed by six votes, 212 to 206. The Senate was tied 50-50, and Vice President Cheney broke the tie. The Senate had previously passed a much better version, but it was totally rejected in a midnight "conference" meeting of a handful of members of Congress, all Republican. For technical reasons the law must be voted again in the House, and that is what happens February 1. There is no new vote in the Senate; if the bill passes the House on February 1, it will go to President Bush, who will sign it into law.

Every Democrat in the House is likely to vote against the budget bill that includes these Medicaid changes, and some Republicans as well. The vote will be close. If your Representative is Republican, urge him or her to vote against the budget bill (calls to Democrats can help too). You can call the Capitol Switchboard toll-free at 800-426-8073 and ask to be connected to your Representative's office. Remember that your Representative did not have time to read the bill before -- but let him or her know that you will remember the upcoming vote in November. If you can do more, write to newspapers, blog, call talk shows, or explain the situation to friends so that they can help as well.

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