MEDICAID FARCE

If the Senate is auditioning for the role of FEMA during Hurricane Katrina, it’s got the part. Foot-dragging, directionless debate, ignoring people in crisis in favor of protocol – it’s all there in the Capitol, epitomized by a debate over how to deliver badly needed Medicaid funding to poor evacuees so they afford medication or go to the doctor if necessary. Nearly two months after the hurricane hit, the theater of Senate deliberations continues.

At issue is a bill by Republican Chuck Grassley of Iowa and Democrat Max Baucus of Montana that would provide up to $9 billion to states with Katrina victims, paying 100 percent of the care, rather than requiring the states to contribute a share. The White House wanted a Katrina Medicaid bill and Sen. Grassley, chairman of the Finance Committee, delivered, but the administration opposes the bill and would prefer having the states apply for Medicaid waivers.

The waivers would concentrate control with Health and Human Services and limit expansions of Medicaid policy. This seems to be the administration’s primary fear – that new classes of poor would qualify for care. It also seems to object to providing additional funds to any state with evacuees, preferring to focus on Louisiana, Alabama and Mississippi.

With a hold on the Grassley-Baucus bill by Republican Sen. John Sununu of New Hampshire, Sen. Grassley has turned to his committee’s portion of the spending cuts agreed to in budget negotiations to try to include at least some added Medicaid funding for Katrina victims. That means he would be cutting Medicaid (and Medicare) while also expanding it, perhaps to the same people. From tragedy to farce without intermission.

Sen. Olympia Snowe, a member of the Finance Committee, once again has been protecting these valuable health care programs and fighting against even higher cuts demanded by the administration. It seems unlikely that the original $9 billion bill will pass the Senate, but Sen. Snowe can play a crucial role in the reconciliation markup, expected next week. She can maintain her position on keeping the total cuts at around the reconciled $10 billion while including Katrina funding and using as offsets some of the industry sops in the Medicare drug legislation.

That is not a great bargain for anyone, but it could get more health care money moving to Katrina victims than any other option currently being discussed. Sen. Snowe has been a skilled defender of these programs that, without her vote, would be in much more serious trouble today. She should stick to her principles again this time.