Doctoring Up Medicaid

...Opponents of cuts charged that many localities were "rigging the books," using health care as a handy excuse to hike taxes when they would have had to do so in any event...

...The action calls into question the very future of public health in the state —and probably in the country?just as it sharply reflects the inability of the unorganized poor to vocalize their basic needs...

...The lament is one of overkill, and nowhere is the imminent demise of Medicaid so apparent as in New York, a state that often acts as the pace setter for national trends...

...In Manhattan, for example, Medicaid has been paying an incredible $94 a day for a patient's bed in a ward...

...In support of the drastic action taken on the national level and in New York, a case can be made for the dangers of overkill...

...Even before Medicaid came into existence, New York had a medical assistance program which set the family of four income eligibility Tom Wilkinson is a political news writer for the Albany Times-Union...

...This would require employers to provide private health insurance plans for their employes and employes' families, thereby shifting the responsibility from government to the private sector...

...In addition to picking up the tab for in-hospital care and other medical services, a principal focus of Medicaid originally was preventive care...

...The sole exceptions in the latter category are the so-called "Federal reimbursables"—the lame, the halt and the blind...

...From the inception of Medicaid in May 1966 to the cutback this March, some 3.1 million New Yorkers joined, and the rate had leveled off at about 200,000 new beneficiaries per month...

...The Governor unveiled his compulsory plan about two months after the passage of Medicaid, amid the strident demands for repeal...

...Their editorials, to be polite, were vitriolic...

...The lowering of income participation levels attacks the symptoms of the program's ills, entirely neglects the abuses (one upstate doctor reportedly made $80,-000 in one year from it), and ignores the scourge of rapidly rising hospital costs...

...And the legislative action deleting so-called "co-insurance" features, which would have required certain recipients to pay 20 per cent of their medical costs, is at best a palliative...

...Democrats countered with $7,000...

...Shortly afterward the tune of the Governor and the Legislators drifted sharply off key...

...the projection under the restructured plan is one in 10...

...In all, 1.6 million beneficiaries stand to lose their coverage, around 700,000 in New York City alone...

...Congressmen in Washington?who had given the initial impetus to the program by specifying that the states must liberalize their public health care standards—peeked incredulously at what was happening in New York and fell all over themselves trying to backtrack...

...NATIONAL REPORTS Doctoring Up Medicaid By Tom Wilkinson Albany The concept of public health care finds its origins deep in the social structure of this country, yet it now lies torn, trampled and seemingly moribund...

...While the newspaper editorials swamped the program in invective, the poor and the medically indigent —broadly defined as those who cannot afford to pay their medical bills and retain enough funds to live decently—signed up in droves for treatment...

...The theory was that if the medically indigent could be persuaded to appear regularly for physical checkups—and not having to pay for them was considered a very attractive inducement—then many illnesses could be checked and cured before they reached the serious stage...

...The bell is tolling for Medicaid, the program conceived in the shadow of Medicare and designed to provide assistance to the class of people known as the "medically indigent...

...Rockefeller suggested a level of $5,700 for a family of four...

...They had no newspaper, no strong voice of organization, yet the simple act of enrolling was eloquent testimony to the program's effectiveness...

...Never within memory of the newsmen covering New York State politics had a program passed with such quiet serenity subsequently erupted with such volcanic intensity...

...Where in the begjruiing they had set no Federal standards for eligibility, they now spoke nervously about the "open-end" aspect of the program and the necessity for controls...

...It has been skewered by the one sword politicians fear most—money...

...All the money they had set aside for the national program would be swallowed up in funding the New York plan, they discovered...

...Even though this restored $3.8 million of the Medicaid funds, the sole reason for the move was to bring the state program back in line with the new Federal standards and insure the state's continued eligibility for Federal reimbursement...

...level at $5,300 for in-hospital care and $4,700 for out-patient treatment...

...Nonetheless, the politicians performed with their customary alacrity upon hearing anguished moans from the treasury...

...Under the Republican plan, which Rockefeller signed on March 12 without comment, the family of four income eligibility was cut from $6,-000 to $5,300, and the vast majority of persons in the 21-64 age group were thrown out of the program entirely...

...A sliding scale (running from $2,900 net income for a single person to $6,000 for a family of four and $9,400 for a family of eight, each with one wage earner) was finally agreed upon...

...Ironically, the testimony of numbers, because it was mute and thus lacked muscle, doomed the program...

...Upstate editorial writers, probably horrified to find that a story had sailed right by them while they were fighting the good fight against the golden nematode, led the crusade...

...They kept mumbling they hadn't known what was in it...

...The Syracuse Post-Standard, carrying aloft the banner of responsibility, trumpeted righteously that Medicaid was "insane, fiscally irresponsible Socialism, and New York's Gigantic Giveaway...

...The ruling by state officials that persons already receiving treatment cannot be deprived of their rights will temporarily soften the cutback but will in the end merely force administrators of the program to define eligibility cutoff dates...

...The plan languished in oblivion, never seeing the light of day in the Legislature...

...The idea has merit, but its effectiveness has been severely handicapped by the deep cuts in the program...

...This year Rockefeller proposed Medicaid reductions amounting to about $200 million in state and local government savings...

...Consequently, vast numbers of persons—particularly the medically indigent—will have to pay increased taxes ostensibly to finance the Medicaid program, but they will derive absolutely no benefit from it...

...Rockefeller responded by pleading for a one-year test of the program, then went around the state saying it would have to be cut if taxes were not raised, and finally spoke fervently of compulsory health insurance as the "first line of defense in health care...

...Amendments to the legislation poured in, a few even got into the program, and lawmakers who had demurely passed the original bill wandered about in dazed bewilderment...

...In the aftermath of the cutback, no locality has yet come forward with an offer to rescind its tax increases...

...But to qualify for the Federal program, a state had to raise any existing participation levels...

...In the public arena, though, cries of outrage are almost always fortissimo, and the resulting action is more often stultifying than rectifying: In the case of New York State, the public health program will be reduced to a level below what it was before Medicaid...

...He proudly referred to his suggestion as a model for the country, noting that its enactment would be the first in any state and might well be the route all states, and even the Federal government, should follow in meeting health care problems...

...Republicans in the Legislature—the great majority of them from upstate counties?went him one better and proposed cuts of $300 million to bring the total allotment down to $580 million...

...Business and labor, usually strange bedfellows, cried "foul" in unison...

...It was estimated that one out of every five New Yorkers would have been able to participate in the original program...

...Local politicians made much of the fact that their treasuries were being stripped bare to meet Medicaid costs: 28 of the 62 counties in the state either raised or installed a sales tax or boosted their real estate tax to generate revenue for the program...

...Representatives and Senators growled about the burdensome cost—split 44-33-33 per cent, respectively, among the Federal, state and local governments...

...The Governor hailed this most liberal Medicaid program in the nation as one of the finest pieces of legislation ever...

...Bills slashing Medicaid to the bone were quickly passed by the New York State Legislature and signed into law last month by Republican Governor Nelson A. Rockefeller...

...While medical care for all ages was expensive, it also was expansive and produced immediate tangible results...

...In the end, the real losers are the people...

...That was in 1966...

...The Federal government, meanwhile, imposed standards for the states where none existed before...

...They charged that compulsory health insurance was nothing but an evasive attempt to shift the burgeoning cost of Medicaid to the private health insurance companies and virtually accused Rockefeller of a sellout...