Standing up and fighting back

To help states cope with the increase in the number of working people on Medicaid because they cannot afford private insurance, President George W. Bush has proposed a $1 billion expansion in services.

But none of that money is likely to come to Missouri, where Gov. Matt Blunt has spearheaded major Medicaid cuts. Estimated cuts to State Medicaid funding are $268.7 million under Senate Bill 539, according to lawmakers. Adding lost federal Medicaid funding and other associated revenues brings the total to $617.3 million.

Those cuts have angered area residents whose loved ones have lost benefits.

“It’s disgraceful what is happening in Missouri,” said Felicia Goins of Terre Du Lac, at a town hall meeting in Potosi. “I would like to leave a message for Matt Blunt. Here in Southeast Missouri, we’re standing up and we’re fighting back.”

Despite recent increases in revenues, Republicans say that the state doesn’t have the money to match additional funding.

“The problem we have in this state is, when you don’t have the money, it doesn’t matter that if you spend $2 you get $5,” State Sen. Kevin Engler, R-Farmington said. “We have to balance the budget.”

Blunt recently signed into law Sen. Bill 539, which cuts services for approximately 340,000 Missouri residents. Beginning next month, at least 90,000 statewide are expected to lose all benefits. About 70 percent are low-income working women, most of whom have children. St. Francois County numbers were unavailable at press time.

Engler voted against the bill because truly needy people can be left without any medical insurance. However, he believes cuts are necessary because the state has used up its reserves while funding optional Medicaid services.

The federal government mandates certain Medicaid programs, but in past years, Missouri has adopted services that are considered optional. Engler said the optional programs were adopted when the state’s fiscal situation was in better shape, but that in the last several years, the state dipped into its reserves to pay for those services.

“Missouri had chosen to provide many wonderful opportunities at a time when the state could afford it,” said Deborah Scott, spokesperson for the Missouri Department of Social Services. “When we had to learn to live within our means, we had to look at those services.”

Cutting the options

Passed as part of an effort to balance the budget, Sen. Bill 539 cuts many of those optional services. Among them: Dental services except treatment for trauma or disease-related conditions; medical equipment including wheel chair batteries, body braces, hospital beds and side rails, walkers, artificial larynxes, BiPap and CPAP machines, nebulizers, special mattresses, and crutches; physical, occupational and speech therapy; hearing aids and testing services; and optical services other than one eye exam every two years.

The cuts do not apply to children, pregnant women, the blind and nursing home residents.

Even though state revenues increased from $6.4 billion to $6.7 billion, the state needs the cuts, proponents of the bill said.

“We’ve been hundreds of millions short between what we took in and spent out,” he said. “We didn’t pay MAC and other colleges until June so we could fund the tax returns.”

Currently, federal funding covers 60 percent of Medicaid costs in Missouri. The rest comes from the state.

However, Democrats at Friday’s town hall meeting argued that the state’s actual Medicaid costs are lower and the number of people affected by the cuts is higher.

“Hospitals and pharmacies pay a self-imposed tax that goes toward our 40 percent, so we actually pay only 17 percent,” said State Sen. Chuck Graham, D-Columbia.

Graham estimated that cuts will affect 500,000 people and about 100,000 people will be eliminated from the program entirely. Hardest hit under the cuts are working poor, the elderly, and citizens with disabilities, he pointed out to more than 30 people who attended the town meeting sponsored by American Federation of State, County and Municipal Employees Quality Home Care Partnership. Several people attended in wheelchairs.

“Republicans say we need to take care of the needy, not the greedy,” said Graham, who also uses a wheelchair. “I don’t see any greedy people here.”

Monthly payments hurt

Lana Richards is totally disabled, but she has managed to raise her orphaned granddaughter with the help of Medicaid insurance. After receiving a letter from the state that assigns her a monthly payment in order to keep her Medicaid, however, the Cadet woman wonders how she and her 12-year-old granddaughter will survive.

The changes require Richards to pay $167 per month to keep her Medicaid insurance, even though she only receives $865 per month in disability payments. The first payment is due by Sept. 1, but Richards does not see how she can afford to buy the health insurance.

“By the time my bills are paid, that’s about all I have left to live on for the month,” she said. “It’s either pay the $167 and I won’t have anything for groceries or gas to get to my doctor’s appointments or don’t pay the $167 and have no medicine or health insurance.”

Robin Struharik attended the meeting on behalf of her father, Ronald Hausmann. Hausmann will have to pay $546 per month to continue Medicaid coverage and another $200 for medicine, Struharik said. That will leave him with less than $300 of his monthly $1,000 disability check to pay all his other bills and buy food.

Without the Medicaid insurance, Hausmann’s liver and kidney medicines alone would cost more than $1,200 – more than his entire monthly disability check.

Adults with low-paying jobs also are hurt by the cuts.

Kerry Bargo of Bismarck struggled to regain her financial independence and finally found a job. Recent cuts threaten that independence, said State Rep. Brad Robinson, D-Bonne Terre. Robinson partnered with Bargo in this year’s Walk-A-Mile program that pairs policy makers with low income residents.

“People are going to have to decide if they want to work or live off the state,” he said.

As a result of the cuts, more citizens are turning to clinics or hospital emergency rooms for health care.

East Missouri Action Agency (EMAA) Family Planning Clinic already has noticed an increase in clients as a result of the cuts, said Angel Prather, family planning director for EMAA. The clinic provides annual exams, PAP smears, breast exams, tests for sexually transmitted diseases and birth control.

From Jan. to June 2005, the clinic saw 1,596 women, compared to a total of 2,897 in 2004. The number of new clients continues to rise as reality sinks in.

“Many of them got letters in July, but didn’t realize they had lost their benefits until they tried to pick up their birth control,” Prather said. “When they lose their physicians, they have to go to the clinics.”

Taxpayers will have to pick up the cost when uninsured residents can’t afford to pay for medical or hospital care.

“The image is that these cuts will save money and we will have better programs,” said State Rep. Belinda Harris, who shares state representation of Washington County with fellow Democrat J.C. Kuessner. “But working class people in their prime working years are realizing their insurance payments and medical costs are going to go up.”

Adding to the problem, Harris said, is the lack of specifics about plans that will be available to Medicaid patients who are able to make the monthly payments. It appears that no plan will cover all medications, she said.

Waste and fraud

Rep. Steven Tilley, R-Perryville, said one of the biggest problems with Medicaid is the number of able-bodied people who receive services.

“I’m a provider and I see it on a daily basis,” said Tilley, an optometrist. “Able-bodied adults who can be working instead are living off the people. We can’t afford that if we are going to help the elderly and disabled.”

Under the current system, people can have unlimited assets and still qualify for Medicaid services, Tilley said. The state also has failed to conduct annual verification audits as required by the federal government, he added.

“We’re going to start doing audits,” Tilley said. “Medicaid isn’t for wealthy people who can hire a lawyer to hide their assets.”

He added that the state should consider offering incentives for employers to provide insurance.

Meanwhile, Blunt has appointed a bi-partisan committee to look at waste, fraud and abuse in Medicaid. The committee will review the new cuts and how they are affecting people of the state, Robinson said.

Residents are welcome to contact the committee, the representative added. Comments and questions may be addressed on the Internet by going to the committee’s Web site at http://www.house.mo.gov/medicaidreform.