The Associated Press
OLYMPIA — For about 850,000 Washington residents, Medicaid is their bridge to health care.
They use it every time they need doctor’s exams, medicine for their kids, or wheelchairs for their parents.
Now Washington state wants to put a toll on that bridge.
The state has submitted an unprecedented proposal to the federal government asking for permission to make some Medicaid recipients pay for services and cap enrollment for some programs. Other states are watching eagerly to see what happens. If the Bush administration approves Washington’s request, it would give states new cost-cutting powers over Medicaid, a joint federal and state health insurance program.
The question is whether the changes would cure Medicaid or kill it.
Dennis Braddock, secretary of the state Department of Social and Health Services, says changing the Medicaid rules is the only hope for keeping the program healthy during a recession.
The state extended Medicaid coverage generously during the boom times of the 1990s. Now Washington can’t afford it, Braddock said, and making people pay for services is the only way to avoid larger cuts.
Some Medicaid clients and advocates for the poor fear the changes could put health care out of reach for many citizens.
"I would have to cease going to the doctor," said Bonnie Chambers, a 30-year-old Lynnwood mother of four. She worked as a nursing aide before she was injured, and her husband’s $22,000-a-year income now supports the family.
"I do not have a $5 or $10 co-pay to pay for my prescriptions," she said. "I do not have that kind of money laying around. I need to decide if I’m going to pay my utility bill or put food on the table."
Braddock is proposing premiums for people above the poverty level and co-pays for coverage that’s not federally required. Clients would probably not pay for core services mandated by Congress, such as basic health care for children under the poverty level.
Some otherwise eligible residents could be shut out of Medicaid. Details would be subject to legislative approval, but Braddock said no Medicaid family would pay more than about 5 percent of its yearly income.
That’s too much, said Chambers and others who rallied at the state Capitol on Friday. A Senate health committee discussed the issue later that day.
"Our families work hard, and they are not going to take away our safety net," Chambers shouted to about 50 protesters standing in the cold rain. "I’m freezing my buns off outside the Capitol because I’m really upset about this."
Congress makes states cover certain groups — for example, children ages 1 through 5 whose families make less than 133 percent of the federal poverty level.
Washington has led the country in expanding optional Medicaid coverage. For instance, Medicaid is available in this state for children ages 1 through 5 whose families make twice the poverty level.
The federal poverty level is $17,650 for a family of four.
The state’s motives for tinkering with Medicaid are simple. Health care costs are skyrocketing and Medicaid costs Washington state $2.5 billion a year. The recession is forcing state leaders to cut costs wherever they can.
The alternative to charging people for subsidized health care, Braddock said, is eliminating chunks of the optional Medicaid program.
"We can offer this benefits package that’s reduced, but it’s better than getting nothing," he said.
Or the state could eviscerate other programs, cuts Braddock believes would hurt more.
"We have a lot of programs more important than health insurance," Braddock said. "There are greater costs to society than someone not getting their physical."
Health care advocates believe Braddock is ignoring other alternatives.
"They insist on picking on low-income families," said Barbara Flye, executive director of Washington Citizen Action, a consumer advocacy group. "They need to go after the real culprits."
Flye said the state should attack high prescription drug costs by joining with other states to purchase drugs in bulk and bargain down the prices.
She also questioned whether people will avoid visiting doctors for preventive care if they have to pay for it. If so, they may end up getting expensive emergency care that will cost society more in the long run.
"You have to look at the overall economic impact," Flye said. "You can’t just look at a column with a number in it."
Braddock said he’s not worried that co-pays and premiums will stop Medicaid clients from getting preventive care. He pointed to the Basic Health Plan, state health insurance covering people who don’t qualify for Medicaid but have similar incomes. That program, with 125,000 enrollees, proves that poor people can pay for subsidized health care, Braddock said.
DSHS submitted the proposal — called a Medicaid Section 1115 Waiver — on Nov. 2. The federal government is supposed to decide within 90 days.
Other states and health experts are watching. Section 1115 waivers historically have been used to expand Medicaid coverage, not limit it. Approval of this waiver would signal a big change in the way states can do business.
"What’s different about the Washington state waiver is that it’s really not about expanding coverage, it’s about cutting the program," said Joan Alker of Families U.S.A, a national health care advocacy group. "We think this would be a very, very dangerous and damaging path and precedent."
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