Stanley Feld M.D.,FACP,MACE
President Bush continues to try to destroy the infrastructure of the healthcare system despite the fact that he is now a lame duck President.
“In the first of an expected avalanche of post-election regulations, the Bush administration on Friday narrowed the scope of services that can be provided to poor people under Medicaid’s outpatient hospital benefit.”
“Public hospitals and state officials immediately protested the action, saying it would reduce Medicaid payments to many hospitals at a time of growing need.”
As the recession deepens, more and more American’s will be uninsured. As more people lose their jobs they will lose their healthcare insurance coverage. America has a defective definition of poverty. Poverty was last defined in 1955. That level is inadequate. A new poverty level must be defined to enable people in need to qualify for Medicaid.
President Bush is trying to eliminate the Medicaid entitlement. However, cities have to attract lower income workers and deal with their healthcare needs. Poverty must be redefined in order to provide Medicaid and keep low income workers in cities and states.
President Bush should realize that no matter what happens to Medicaid the government is going to be the payer of last resort. It would be wise to provide preventive medical care with incentives to the poor to avoid illness before they develop complications of chronic diseases. End-stage kidney disease is on the rise because hypertension and diabetes is not controlled. Dialysis consume 32 billion dollar a year in Medicare and Medicaid funds
“The new rule conflicts with efforts by Congressional leaders and governors to increase federal aid to the states for Medicaid as part of a new economic action plan. “
President-elect Barack Obama has endorsed those efforts to redefine poverty. The Bush administration continues to issue executive orders that will compromise safety net hospitals.
“In a notice published Friday in the Federal Register, the Bush administration said it had to clarify the definition of outpatient hospital services because the current ambiguity had allowed states to claim excessive payments.”
The administration’s excuse is transparent. The fiscal integrity of Medicaid has already been compromised.
“This rule represents a new initiative to preserve the fiscal integrity of the Medicaid program,” the notice said.
After the rule was published a series of protests appeared but has fallen on deaf ears. The administration is willing to bail out the banking system and institutions like AIG as well as the auto industry. Yet it does not permit a vital rung of our healthcare system to survive.
Reform of the Medicaid system is needed. The solution is not slashes in funding at this difficult time. The short and long term effects of destroying Medicaid supported institutions on our economy and health of the underprivileged is great.
“John W. Bluford III, the president of Truman Medical Centers in Kansas City, Mo., said: “This is a disaster for safety-net institutions like ours.
Alan D. Aviles, the president of the New York City Health and Hospitals Corporation, the largest municipal health care system in the country, said: “The new rule forces us to consider reducing some outpatient services like dental and vision care. State and local government cannot pick up these costs. If anything, we expect to see additional cuts at the state level.”
New York State and California is bankrupt and looking for bail out money.
“Carol H. Steckel, the commissioner of the Alabama Medicaid Agency, said the rule would reduce federal payments for outpatient services at two large children’s hospitals, in Birmingham and Mobile.”
“Richard J. Pollack, the executive vice president of the American Hospital Association, said “The new regulation will jeopardize important community-based services, including screening, diagnostic and dental services for children, as well as lab and ambulance services.”
Whatever the government claims it is not fixing the healthcare system’s problem. It is creating a larger healthcare system problem.
“Matt D. Salo, a health policy specialist at the National Governors Association, said, “The new rule is consistent with the administration’s effort to squeeze, shrink and flatten Medicaid spending.”
Ann Clemency Kohler, the executive director of the National Association of State Medicaid Directors, said: “We have to question why the rule is being issued now, three days after the election, with a new administration coming in.”
Ms. Kohler said the rule would cut “money going to the states, to safety net providers, at a time when states are really being stressed.”
Larry S. Gage, the president of the National Association of Public Hospitals, said, “We will urge Congress to extend the moratorium to this rule, and we will ask the Obama administration to withdraw it.”
These continuing destructive actions by the Bush administration will not enhance the possibility of him having a positive legacy. He is doing more damage to America’s fragile infrastructure.