Report Sees Health Catastrophe if Cuts Reduce Medicaid : Study: Groups warn of reductions in projected spending growth. GOP lawmakers call document a scare tactic.
Medicaid funding cuts proposed by Congress to balance the federal budget could set off a health care catastrophe far worse than the one that gripped Los Angeles County a decade ago, when ambulances roamed the streets looking for an open emergency room, trauma centers shut down and lives were needlessly lost for lack of care, a national study warned Wednesday.
The report predicts a grim future for the nation’s health care network should the Republican-led Congress go forward with its plan to reduce by $182 billion over seven years the projected growth in funding for Medicaid, the federal-state program providing health care for the poor, including doctor and hospital services and custodial nursing home care.
The most massive Medicaid cuts ever contemplated by Congress would leave more than 8 million people without health coverage--one in seven of them Californians--the study concluded. But the resulting erosion of care would affect even the medically insured by over-burdening the health care system on which all consumers depend, according to the research by the National Health Law Program in Washington and Consumers Union in San Francisco, which publishes Consumer Reports.
“Great harm may befall many of the more than 8 million people who are projected to be denied coverage under proposed congressional cuts,” the report said. “Medicaid beneficiaries probably would lose coverage and suffer grave, irreversible harm. Key elements of our health care infrastructure, such as the emergency care system, could suffer serious damage. People of all income levels who depend on this system could have their health endangered precisely when they most desperately need care.”
In its 1996 budget resolution, Congress has proposed reducing Medicaid funds and handing over the money to states in the form of block grants as part of a plan to wipe out the deficit in seven years and pay for tax reductions. They argue that the Medicaid cuts will be offset by reduced costs and more efficient management of the program at the state level.
Republican lawmakers called the study a scare tactic because no formula for reduction has yet been written.
“Easing back on the throttle does not mean the train is going to stop. It simply means we are trying to slow a train that is speeding out of control,” said Rep. Brian Bilbray (R-San Diego), a member of the Commerce Committee, which oversees Medicaid. “Until a formula is finalized, it is irresponsible to make allegations of an impending crisis. This is merely a scare tactic, one with no basis in fact.”
But the authors of the report contend that the impact of such unprecedented reductions can be predicted with a look back at California in the mid-1980s, when the state’s Medicaid program--known as Medi-Cal--was slashed, the largest cutback of its kind nationally in recent years.
The research conjured up some bad memories of a health care crisis that struck Los Angeles County harder than any other part of the state:
* The county’s trauma care system, formerly a national model, collapsed under the strain of providing unreimbursed emergency care to a glut of uninsured patients.
* Patients with hypertension who lost Medicaid coverage experienced a rise in blood pressure so severe that the risk of death increased fourfold within six months. Within one year, seven people in a 186-person sample group of the newly uninsured died; at least four of those deaths were “clearly associated with worsened access to care as patients could no longer afford to see the doctor or have prescriptions filled.”
* Roughly twice a week, not one of the 13 hospital emergency rooms in Central Los Angeles was open to ambulances, prompting one hospital emergency director to conclude: “You’d be better off having a heart attack in Mexico City than in Los Angeles.”
* Many physicians, including maternity care providers, stopped accepting Medicaid patients. More than 140,000 Medicaid-eligible women of child-bearing age lived in counties without access to Medicaid maternity care.
“These consequences resulted from an 18% cut in California’s projected Medicaid spending. Under current congressional proposals, the average state would cut projected spending by 30%--almost 50% deeper than California’s experience in the ‘80s,” the report said.
Furthermore, it said, states could not seek the remedy that helped end California’s emergency room crisis in 1989--increased federal Medicaid funding--because Congress has proposed capping each state’s share of federal Medicaid money.
“We think when the public realizes what the possibilities are as a consequence of these proposals, they won’t stand for it. That’s not what we expect from our country,” said Jeanne Finberg, senior staff attorney and health policy analyst at Consumers Union, who co-authored the report with Stan Dorn, managing attorney at the National Health Law Program.
“It’s pretty bone-chilling,” Rep. Henry Waxman (D-Los Angeles), a Commerce Committee member who opposes the proposed cuts, said of the study. “We have seen what really happened when the federal government cut back in the 1980s and it isn’t hard to figure out what will happen if we do even a worse job by making sure there will never be enough federal money for states to meet their responsibilities to low-income people.”
Many health care providers nodded in vigorous agreement with the study’s conclusions. “There can be no question the impact would be extraordinary,” said Dr. Reed Tuckson, president of the Charles Drew University of Medicine and Science in Los Angeles. “People are going to die by the thousands, and their deaths will not make it on the [political] radar screen.”
He said the crisis currently threatening to shut down hospitals and health clinics in Los Angeles County is evidence of what lack of federal money can do. And not just to the poor, he stressed. Reduced health services can lead to an increase in infectious diseases that observe no economic boundaries.
“These are the people who care for our children in day care, on our playgrounds,” Tuckson said. “We are at great peril. When we retire in the evening to the security of our gated communities, the tuberculosis bacilli can squeeze right through the bars of those gates.”
