REVISITING MEDICAID

Even before President Bush proposed taking $44 billion out of planned Medicaid increases, members of the Senate were wondering about the direction of the major program that provides health care coverage to the poor. With the president’s budget, they have even more reason to worry about it now, so the proposal to form a state-federal study commission on the issue is a good one.

Republican Sen. Gordon Smith of Oregon and Democratic Sen. Jeff Bingaman of New Mexico have proposed a commission to review the long-term goals of Medicaid, examine who is being served, whether the program is financially stable, how it works with Medicare and whether the quality of care is acceptable.

Maine Sens. Olympia Snowe and Susan Collins support the bill. Sen. Snowe last week said, “the federal government cannot abandon its responsibility to the states for helping to provide and expand access to health care for low-income and uninsured Americans.”

Without a better-organized national health care system, Washington has left the job of caring for the poor to the states. Leaving the responsibility to the states while cutting the money expected to pay for the care guarantees that a lot of people will lose out, as will the service providers who would see their payments cut. Maine has expanded Medicaid significantly in the last couple of years, extending it to more people to try to provide needed care and avoid the cost-shifting to private plans, so the federal funding is especially important here.

The commission plans to take a year to conclude its findings, which is too long to do anything with the 2006 budget but stall the changes proposed by the president. Interim reports should give it some idea of what the president’s plans would mean and how states would be affected.

Certainly, an effective commission would find savings within state Medicaid programs – at the least, it would establish priorities for determining what represents an adequate program. But the current proposal sets policy by reducing expected funds, which is no way to tinker with someone’s health care coverage. A commission could make sense of the coming changes, point to inadequacies of the current funding system and steer Medicaid toward a healthier future.