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THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
THE UNITED STATES
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduce Medicaid Payments to States by 30 Percent in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20 percent over seven years and 30 percent in 2002. Even if
states absorb half of the cuts by reducing services and provider payments, they would still
have to eliminate coverage for 8.8 million people in 2002, according to the Urban Institute.
Over 40 percent of all people losing coverage would be concentrated in five states: California,
Florida, New York, Texas and North Carolina. The 8.8 million who lose coverage includes:
920,000 older Americans;
1.4 million people with disabilities; and
6.3 million children and their families.
The Republican proposal would force states to eliminate coverage for about 350,000
nursing home residents and another 330,000 people needing home care in 2002.*
Medicaid is the largest insurer of long-term care for all Americans, including the middle class.
Currently, Medicaid covers 68 percent of the nation's 1.3 million nursing home residents.
Medicaid also serves about 1.4 million older Americans and people with disabilities using
home care. Without Medicaid, families could not afford nursing home care that costs an
average of $38,000 per year.
The Republican proposal would force states to eliminate coverage for 4.4 million children
in 2002.* Currently, over 20 percent of the nation's children rely on Medicaid for their basic
health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case
of emergencies for about 18 million children.
States could avoid these difficult choices only by increasing their Medicaid spending by 40
percent in 2002 -- by raising property or sales taxes, or cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
Methodology for the Medicaid State Estimates
The following describes the sources for the estimates in the September 14, 1995 White House
Medicaid document.
Most of the estimates come from the July 1995 report by the Urban Institute entitled: "The
Impact of the Budget Resolution Conference Agreement on Medicaid Expenditures" (July 1995).
This report and supplemental analyses by the Urban Institute are the source for:
Dollar and percent reduction in Federal Medicaid payments by state;
Number of total people losing coverage, number of people in families, elderly, and
disabled losing coverage under the proposal.
The estimates for the number of children and nursing home residents and home health users
losing coverage were calculated by the Department of Health and Human Services based on the
Urban Institute data. Both sets of estimates were derived by: (a) calculating the number of
children and nursing home residents and home health users in 1993 as a percent of people in
families and the aged and disabled, respectively; and (b) applying those percentages to the
number of people in families and aged and disabled losing coverage in 2002. For example, in
California, 62.3 percent of people in families were children in FY 1993. It was assumed that
within families there is no disproportionate reductions in coverage of adults or children -- people
are cut in proportion to their representation the group. This percent of children was multiplied by
the Urban Institute estimate of the number of people in families losing coverage -- 918,095 -- to
estimate that about 571,700 children in California could lose coverage in 2002.
The estimated increase in state spending to offset the loss of Federal funds was also calculated by
the Department of Health and Human Services based on the Urban Institute data. This
percentage increase was based on the Urban Institute's estimates of Federal baseline spending in
2002 and the reduction resulting from the proposal. Using the 1996 FMAPs, the state share in
2002 was estimated. Then, the reduction resulting from the proposal was added to the estimated
state share to calculate the percent increase in state share if the state increased its spending to
offset the loss of Federal funds.
Other facts in the document come from secondary sources. The percent of children covered by
Medicaid by state comes from the March 1994 Current Population Survey. The number of
children and home care users covered by Medicaid by state comes from the 1994 Health Care
Financing Administration tabulation of 2082 data, submitted by states. The data on nursing
home residents come from Harrington, Thollaug and Summers' report: "State Data Book on
Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1991 - 1991" (January 1995).
The Republican Budget Resolution Conference Agreement:
Estimated Number of People Losing Health Coverage, 2002
STATE
TOTAL
Aged
Disabled
Families:
Long-Term
Children
Adults & Kids
Care Users
U.S.
8.8 million
920,000
1.4 million
6.3 million
680,000
4.4 million
Alabama
102,000
12,300
25,500
64,500
11,000
45,800
Alaska
22,000
1,200
1,900
19,200
na
12,700
Arizona
110,000
na
na
na
na
na
Arkansas
122,000
16,200
29,200
76,900
13,300
53,100
California
1.2 million
95,000
145,800
918,100
34,400
571,700
Colorado
97,000
10,700
16,800
70,000
9,200
48,000
Connecticut
74,000
7,500
12,300
54,200
11,800
37,100
Delaware
21,000
1,400
3,200
16,800
1,900
12,100
District of Columbia
20,000
1,500
4,400
14,400
1,500
10,100
Florida
706,000
78,900
94,900
532,100
49,100
423,000
Georgia
383,000
41,200
63,900
277,800
24,600
188,900
Hawaii
36,000
3,400
5,600
27,500
1,500
18,700
Idaho
34,000
3,100
5,500
25,500
2,400
17,800
Illinois
274,000
22,000
55,900
196,100
25,800
137,900
Indiana
112,000
11,800
17,400
83,200
11,000
56,800
Iowa
69,000
8,700
11,700
49,100
8,500
32,800
Kansas
40,000
4,500
6,100
29,200
4,500
19,700
Kentucky
171,000
17,700
43,200
110,600
22,400
73,400
Louisiana
154,000
16,600
26,800
111,000
3,900
79,000
Maine
34,000
4,300
7,200
23,000
3,500
15,400
Maryland
116,000
10,600
22,200
83,200
7,400
58,900
Massachusetts
210,000
24,100
43,600
142,200
22,900
94,700
Michigan
215,000
15,200
42,400
157,000
22,900
100,700
Minnesota
88,000
11,300
12,100
64,300
47,000
43,900
Mississippi
141,000
18,200
29,900
92,900
5,700
67,300
Missouri
83,000
10,200
13,000
59,600
7,900
39,300
Montana
27,000
3,000
5,600
18,300
2,100
10,100
Nebraska
41,000
4,700
5,500
31,000
4,200
23,100
Nevada
26,000
2,900
4,100
19,000
1,800
12,900
New Hampshire
1,100
na
na
na
na
na
New Jersey
166,000
15,300
29,000
121,600
16,700
79,600
New Mexico
80,000
8,000
17,100
55,300
4,200
37,500
New York
645,000
66,400
100,400
478,200
71,300
343,700
North Carolina
455,000
79,300
64,000
312,300
40,900
204,600
North Dakota
18,000
2,700
2,300
12,600
2,300
8,800
Ohio
292,000
32,200
50,100
209,800
28,000
143,100
Oklahoma
125,000
14,000
16,400
94,200
3,700
65,800
Oregon
118,000
8,900
15,400
94,100
8,600
62,700
Pennsylvania
308,000
31,600
67,300
209,400
22,200
150,800
Rhode Island
51,000
7,800
11,200
32,100
12,000
21,600
Continued
The Republican Budget Resolution Conference Agreement:
Estimated Number of People Losing Health Coverage, 2002
Continued
STATE
TOTAL
Aged
Disabled
Families:
Long-Term
Children
Adults & Kids
Care Users
U.S.
8.8 million
920,000
1.4 million
6.3 million
680,000
4.4 million
South Carolina
149,000
21,300
24,700
102,600
7,800
73,300
South Dakota
19,000
2,300
3,300
13,300
2,100
9,600
Tennessee
246,000
27,800
61,000
157,000
5,800
112,000
Texas
687,000
66,800
68,500
551,600
43,100
394,100
Utah
53,000
3,200
6,200
43,800
3,100
29,000
Vermont
20,000
2,400
3,500
14,200
1,900
9,000
Virginia
236,000
32,400
36,400
167,100
17,800
117,000
Washington
183,000
12,900
29,500
140,500
8,200
91,200
West Virginia
140,000
13,200
26,100
100,300
5,400
60,200
Wisconsin
94,000
12,800
23,000
58,000
11,300
42,600
Wyoming
15,000
1,000
1,700
12,200
1,600
8,500
NOTES:
Numbers are rounded to the nearest hundred or thousand; as a result numbers may not sum to totals due to rounding.
"Long-term care users" include residents of skilled nursing facilities and users of home care. The "aged",
"disabled" and "families: adults & kids" columns sum to the total recipients. The number of long-term care
recipients and children losing coverage are subsets of the "aged", "disabled" and "families: adults & kids" estimates
and thus cannot be added to these estimates. The first four columns are from the Urban Institute's Medicaid
Expenditure Growth Model. The last two columns are U.S. Department of Health and Human Services' estimates
based on the Urban Institute's estimates. All are based on the assumption that states could achieve approximately
half of the savings target through reducing their growth rate per recipient to inflation plus 1.9 percent. Data for
Arizona, Alaska and New Hampshire were insufficient for these analyses.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
ALABAMA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Alabama would
lose $2 billion over the seven years, a 22% reduction in 2002 alone. Even if Alabama could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 102,000 people in 2002, according to the Urban Institute, including:
12,300 older Americans;
25,500 people with disabilities; and
64,500 children and their families.
The Republican proposal would force Alabama to eliminate coverage for about 11,000
people needing long-term care in 2002.' Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 72% of the 19,500
nursing home residents in Alabama. Medicaid also serves about 37,400 older Americans and
people with disabilities using home care in Alabama. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Alabama to eliminate coverage for 45,800 children
in 2002.' Currently, 16% of the children in Alabama rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 244,000 children in Alabama.
Alabama could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 51% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health.& Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
ALASKA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Alaska would lose
$429 million over the seven years, a 32% reduction in 2002 alone. Even if Alaska could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 22,000 people in 2002, according to the Urban Institute, including:
1,200 older Americans;
1,900 people with disabilities; and
19,200 children and their families.
The Republican proposal would force Alaska to eliminate coverage for a significant
number of people needing long-term care in 2002.* Medicaid is the largest insurer of long-
term care for all Americans, including the middle class. Currently, Medicaid covers 86% of
the 500 nursing home residents in Alaska. Medicaid also serves about 1,000 older Americans
and people with disabilities using home care in Alaska. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Alaska to eliminate coverage for 12,700 children in
2002. Currently, 20% of the children in Alaska rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 39,000 children in Alaska.
Alaska could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 32% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data: numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
ARIZONA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Arizona would
lose $3 billion over the seven years, a 33% reduction in 2002 alone. Even if Arizona could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 110,000 people in 2002, according to the Urban Institute.
The Republican proposal would force Arizona to eliminate coverage for a significant
number of people needing long-term care in 2002.* Medicaid is the largest insurer of long-
term care for all Americans, including the middle class. Currently, Medicaid covers 59% of
the 10,500 nursing home residents in Arizona. Medicaid also serves about 11,700 older
Americans and people with disabilities using home care in Arizona. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
The Republican proposal would force Arizona to eliminate coverage for a significant
number of children in 2002. Currently, 15% of the children in Arizona rely on Medicaid
for their basic health needs. Medicaid pays for immunizations, regular check-ups, and
intensive care in case of emergencies for about 310,000 children in Arizona.
Arizona could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 63% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
Note: Due to data limitations, specific estimates for Arizona are not available.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
ARKANSAS
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Arkansas would
lose $2 billion over the seven years, a 33% reduction in 2002 alone. Even if Arkansas
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 122,000 people in 2002, according to the Urban Institute, including:
16,200 older Americans;
29,200 people with disabilities; and
76,900 children and their families.
The Republican proposal would force Arkansas to eliminate coverage for about 13,300
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 78% of the 19,800
nursing home residents in Arkansas. Medicaid also serves about 19,500 older Americans and
people with disabilities using home care in Arkansas. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Arkansas to eliminate coverage for 53,100 children
in 2002.* Currently, 20% of the children in Arkansas rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 112,000 children in Arkansas.
Arkansas could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 93% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
CALIFORNIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. California would
lose $18 billion over the seven years, a 31% reduction in 2002 alone. Even if California
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 1.2 million people in 2002, according to the Urban Institute, including:
95,000 older Americans;
145,800 people with disabilities; and
918,100 children and their families.
The Republican proposal would force California to eliminate coverage for about 34,400
people needing long-term care in 2002.' Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 66% of the 90,400
nursing home residents in California. Medicaid also serves about 56,400 older Americans and
people with disabilities using home care in California. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force California to eliminate coverage for 571,700
children in 2002.* Currently, 26% of the children in California rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 2,260,000 children in California.
California could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 31% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
COLORADO
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Colorado would
lose $2 billion over the seven years, a 31% reduction in 2002 alone. Even if Colorado
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 97,000 people in 2002, according to the Urban Institute, including:
10,700 older Americans;
16,800 people with disabilities; and
70,000 children and their families.
The Republican proposal would force Colorado to eliminate coverage for about 9,200
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 62% of the 16,100
nursing home residents in Colorado. Medicaid also serves about 12,000 older Americans and
people with disabilities using home care in Colorado. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Colorado to eliminate coverage for 48,000 children
in 2002.* Currently, 14% of the children in Colorado rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 142,000 children in Colorado.
Colorado could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 34% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
CONNECTICUT
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Connecticut
would lose $1 billion over the seven years, a 21% reduction in 2002 alone. Even if
Connecticut could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 74,000 people in 2002, according to the Urban
Institute, including:
7,500 older Americans;
12,300 people with disabilities; and
54,200 children and their families.
The Republican proposal would force Connecticut to eliminate coverage for about 11,800
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 68% of the 25,800
nursing home residents in Connecticut. Medicaid also serves about 22,100 older Americans
and people with disabilities using home care in Connecticut. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average of $38,000
per year nationally.
The Republican proposal would force Connecticut to eliminate coverage for 37,100
children in 2002. * Currently, 14% of the children in Connecticut rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 166,000 children in Connecticut.
Connecticut could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 21% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
DELAWARE
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Delaware would
lose $331 million over the seven years, a 30% reduction in 2002 alone. Even if Delaware
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 21,000 people in 2002, according to the Urban Institute, including:
1,400 older Americans;
3,200 people with disabilities; and
16,800 children and their families.
The Republican proposal would force Delaware to eliminate coverage for about 1,900
people needing long-term care in 2002.' Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 55% of the 3,000
nursing home residents in Delaware. Medicaid also serves about 4,400 older Americans and
people with disabilities using home care in Delaware. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Delaware to eliminate coverage for 12,100 children
in 2002. Currently, 16% of the children in Delaware rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 40,000 children in Delaware.
Delaware could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 31% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
DISTRICT OF COLUMBIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. District of
Columbia would lose $863 million over the seven years, a 31% reduction in 2002 alone.
Even if District of Columbia could absorb half of the cuts by reducing services and provider
payments, it would still have to eliminate coverage for 20,000 people in 2002, according to the
Urban Institute, including:
1,500 older Americans;
4,400 people with disabilities; and
14,400 children and their families.
The Republican proposal would force District of Columbia to eliminate coverage for
about 1,500 people needing long-term care in 2002.* Medicaid is the largest insurer of
long-term care for all Americans, including the middle class. Currently, Medicaid covers
91% of the 2,700 nursing home residents in District of Columbia. Medicaid also serves about
2,900 older Americans and people with disabilities using home care in District of Columbia.
Without Medicaid, families of the elderly and disabled could not afford nursing home care that
costs an average of $38,000 per year nationally.
The Republican proposal would force District of Columbia to eliminate coverage for
10,100 children in 2002.' Currently, 45% of the children in District of Columbia rely on
Medicaid for their basic health needs. Medicaid pays for immunizations, regular check-ups,
and intensive care in case of emergencies for about 67,000 children in District of Columbia.
District of Columbia could avoid these difficult choices forced by the Republican proposal
only by increasing its Medicaid spending by 31% in 2002 -- by raising property or sales taxes,
or cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
FLORIDA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Florida would
lose $10 billion over the seven years, a 35% reduction in 2002 alone. Even if Florida could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 706,000 people in 2002, according to the Urban Institute, including:
78,900 older Americans;
94,900 people with disabilities; and
532,100 children and their families.
The Republican proposal would force Florida to eliminate coverage for about 49,100
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 62% of the 59,000
nursing home residents in Florida. Medicaid also serves about 70,500 older Americans and
people with disabilities using home care in Florida. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Florida to eliminate coverage for 423,000 children
in 2002. Currently, 23% of the children in Florida rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 991,000 children in Florida.
Florida could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 44% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
GEORGIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Georgia would
lose $6 billion over the seven years, a 35% reduction in 2002 alone. Even if Georgia could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 383,000 people in 2002, according to the Urban Institute, including:
41,200 older Americans;
63,900 people with disabilities; and
277,800 children and their families.
The Republican proposal would force Georgia to eliminate coverage for about 24,600
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 82% of the 34,700
nursing home residents in Georgia. Medicaid also serves about 21,700 older Americans and
people with disabilities using home care in Georgia. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Georgia to eliminate coverage for 188,900 children
in 2002.* Currently, 17% of the children in Georgia rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 543,000 children in Georgia.
Georgia could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 56% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
HAWAII
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Hawaii would
lose $572 million over the seven years, a 32% reduction in 2002 alone. Even if Hawaii
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 36,000 people in 2002, according to the Urban Institute, including:
3,400 older Americans;
5,600 people with disabilities; and
27,500 children and their families.
The Republican proposal would force Hawaii to eliminate coverage for about 1,500 people
needing long-term care in 2002.' Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 72% of the 1,500 nursing
home residents in Hawaii. Medicaid also serves about 900 older Americans and people with
disabilities using home care in Hawaii. Without Medicaid, families of the elderly and disabled
could not afford nursing home care that costs an average of $38,000 per year nationally.
The Republican proposal would force Hawaii to eliminate coverage for 18,700 children in
2002. * Currently, 15% of the children in Hawaii rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 60,000 children in Hawaii.
Hawaii could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 32% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
IDAHO
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Idaho would lose
$542 million over the seven years, a 29% reduction in 2002 alone. Even if Idaho could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 34,000 people in 2002, according to the Urban Institute, including:
3,100 older Americans;
5,500 people with disabilities; and
25,500 children and their families.
The Republican proposal would force Idaho to eliminate coverage for about 2,400 people
needing long-term care in 2002.* Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 61% of the 4,200 nursing
home residents in Idaho. Medicaid also serves about 4,000 older Americans and people with
disabilities using home care in Idaho. Without Medicaid, families of the elderly and disabled
could not afford nursing home care that costs an average of $38,000 per year nationally.
The Republican proposal would force Idaho to eliminate coverage for 17,800 children in
2002.* Currently, 15% of the children in Idaho rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 59,000 children in Idaho.
Idaho could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 65% in 2002 -- by raising property or sales taxes, or cutting other
critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
ILLINOIS
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Illinois would lose
$6 billion over the seven years, a 30% reduction in 2002 alone. Even if Illinois could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 274,000 people in 2002, according to the Urban Institute, including:
22,000 older Americans;
55,900 people with disabilities; and
196,100 children and their families.
The Republican proposal would force Illinois to eliminate coverage for about 25,800
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 64% of the 77,800
nursing home residents in Illinois. Medicaid also serves about 40,500 older Americans and
people with disabilities using home care in Illinois. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Illinois to eliminate coverage for 137,900 children
in 2002. Currently, 21% of the children in Illinois rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 719,000 children in Illinois.
Illinois could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 30% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
INDIANA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Indiana would
lose $4 billion over the seven years, a 30% reduction in 2002 alone. Even if Indiana could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 112,000 people in 2002, according to the Urban Institute, including:
11,800 older Americans;
17,400 people with disabilities; and
83,200 children and their families.
The Republican proposal would force Indiana to eliminate coverage for about 11,000
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 66% of the 28,500
nursing home residents in Indiana. Medicaid also serves about 7,600 older Americans and
people with disabilities using home care in Indiana. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Indiana to eliminate coverage for 56,800 children in
2002.* Currently, 18% of the children in Indiana rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 319,000 children in Indiana.
Indiana could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 50% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
IOWA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Iowa would lose
$1 billion over the seven years, a 27% reduction in 2002 alone. Even if Iowa could absorb
half of the cuts by reducing services and provider payments, it would still have to eliminate
coverage for 69,000 people in 2002, according to the Urban Institute, including:
8,700 older Americans;
11,700 people with disabilities; and
49,100 children and their families.
The Republican proposal would force Iowa to eliminate coverage for about 8,500 people
needing long-term care in 2002.* Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 49% of the 29,300
nursing home residents in Iowa. Medicaid also serves about 15,100 older Americans and
people with disabilities using home care in Iowa. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Iowa to eliminate coverage for 32,800 children in
2002.' Currently, 8% of the children in Iowa rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 136,000 children in Iowa.
Iowa could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 48% in 2002 - by raising property or sales taxes, or cutting other
critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
LOUISIANA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Louisiana would
lose $5 billion over the seven years, a 25% reduction in 2002 alone. Even if Louisiana
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 154,000 people in 2002, according to the Urban Institute, including:
16,600 older Americans;
26,800 people with disabilities; and
111,000 children and their families.
The Republican proposal would force Louisiana to eliminate coverage for about 3,900
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 82% of the 28,900
nursing home residents in Louisiana. Medicaid also serves about 15,200 older Americans and
people with disabilities using home care in Louisiana. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Louisiana to eliminate coverage for 79,000 children
in 2002.* Currently, 30% of the children in Louisiana rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 376,000 children in Louisiana.
Louisiana could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 63% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MAINE
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Maine would lose
$675 million over the seven years, a 22% reduction in 2002 alone. Even if Maine could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 34,000 people in 2002, according to the Urban Institute, including:
4,300 older Americans;
7,200 people with disabilities; and
23,000 children and their families.
The Republican proposal would force Maine to eliminate coverage for about 3,500 people
needing long-term care in 2002.' Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 78% of the 8,000 nursing
home residents in Maine. Medicaid also serves about 8,000 older Americans and people with
disabilities using home care in Maine. Without Medicaid, families of the elderly and disabled
could not afford nursing home care that costs an average of $38,000 per year nationally.
The Republican proposal would force Maine to eliminate coverage for 15,400 children in
2002. * Currently, 19% of the children in Maine rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 77,000 children in Maine.
Maine could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 37% in 2002 -- by raising property or sales taxes, or cutting other
critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MARYLAND
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Maryland would
lose $3 billion over the seven years, a 32% reduction in 2002 alone. Even if Maryland
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 116,000 people in 2002, according to the Urban Institute, including:
10,600 older Americans;
22,200 people with disabilities; and
83,200 children and their families.
The Republican proposal would force Maryland to eliminate coverage for about 7,400
people needing long-term care in 2002.' Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 67% of the 21,900
nursing home residents in Maryland. Medicaid also serves about 14,200 older Americans and
people with disabilities using home care in Maryland. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Maryland to eliminate coverage for 58,900 children
in 2002. Currently, 14% of the children in Maryland rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 198,000 children in Maryland.
Maryland could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 32% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MASSACHUSETTS
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Massachusetts
would lose $4 billion over the seven years, a 28% reduction in 2002 alone. Even if
Massachusetts could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 210,000 people in 2002, according to the Urban
Institute, including:
24,100 older Americans;
43,600 people with disabilities; and
142,200 children and their families.
The Republican proposal would force Massachusetts to eliminate coverage for about
22,900 people needing long-term care in 2002.* Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers 73% of the
44,400 nursing home residents in Massachusetts. Medicaid also serves about 38,900 older
Americans and people with disabilities using home care in Massachusetts. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
The Republican proposal would force Massachusetts to eliminate coverage for 94,700
children in 2002.' Currently, 19% of the children in Massachusetts rely on Medicaid for
their basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive
care in case of emergencies for about 304,000 children in Massachusetts.
Massachusetts could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 28% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MICHIGAN
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Michigan would
lose $6 billion over the seven years, a 30% reduction in 2002 alone. Even if Michigan
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 215,000 people in 2002, according to the Urban Institute, including:
15,200 older Americans;
42,400 people with disabilities; and
157,000 children and their families.
The Republican proposal would force Michigan to eliminate coverage for about 22,900
people needing long-term care in 2002.' Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 67% of the 38,700
nursing home residents in Michigan. Medicaid also serves about 76,000 older Americans and
people with disabilities using home care in Michigan. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Michigan to eliminate coverage for 100,700 children
in 2002. Currently, 23% of the children in Michigan rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 571,000 children in Michigan.
Michigan could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 39% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MINNESOTA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Minnesota would
lose $2 billion over the seven years, a 25% reduction in 2002 alone. Even if Minnesota
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 88,000 people in 2002, according to the Urban Institute, including:
11,300 older Americans;
12,100 people with disabilities; and
64,300 children and their families.
The Republican proposal would force Minnesota to eliminate coverage for about 47,000
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 64% of the 41,500
nursing home residents in Minnesota. Medicaid also serves about 187,800 older Americans
and people with disabilities using home care in Minnesota. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Minnesota to eliminate coverage for 43,900 children
in 2002.* Currently, 16% of the children in Minnesota rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 193,000 children in Minnesota.
Minnesota could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 30% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MISSISSIPPI
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Mississippi would
lose $2 billion over the seven years, a 30% reduction in 2002 alone. Even if Mississippi
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 141,000 people in 2002, according to the Urban Institute, including:
18,200 older Americans;
29,900 people with disabilities; and
92,900 children and their families.
The Republican proposal would force Mississippi to eliminate coverage for about 5,700
people needing long-term care in 2002. Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 82% of the 14,600
nursing home residents in Mississippi. Medicaid also serves about 5,300 older Americans and
people with disabilities using home care in Mississippi. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Mississippi to eliminate coverage for 67,300
children in 2002. Currently, 28% of the children in Mississippi rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 258,000 children in Mississippi.
Mississippi could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 107% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MISSOURI
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Missouri would
lose $1 billion over the seven years, a 17% reduction in 2002 alone. Even if Missouri could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 83,000 people in 2002, according to the Urban Institute, including:
10,200 older Americans;
13,000 people with disabilities; and
59,600 children and their families.
The Republican proposal would force Missouri to eliminate coverage for about 7,900
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 65% of the 33,500
nursing home residents in Missouri. Medicaid also serves about 26,700 older Americans and
people with disabilities using home care in Missouri. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Missouri to eliminate coverage for 39,300 children
in 2002. Currently, 22% of the children in Missouri rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 328,000 children in Missouri.
Missouri could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 25% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
MONTANA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Montana would
lose $766 million over the seven years, a 33% reduction in 2002 alone. Even if Montana
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 27,000 people in 2002, according to the Urban Institute, including:
3,000 older Americans;
5,600 people with disabilities; and
18,300 children and their families.
The Republican proposal would force Montana to eliminate coverage for about 2,100
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 62% of the 6,000
nursing home residents in Montana. Medicaid also serves about 0 older Americans and people
with disabilities using home care in Montana. Without Medicaid, families of the elderly and
disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Montana to eliminate coverage for 10,100 children
in 2002. Currently, 15% of the children in Montana rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 34,000 children in Montana.
Montana could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 75% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEBRASKA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Nebraska would
lose $728 million over the seven years, a 27% reduction in 2002 alone. Even if Nebraska
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 41,000 people in 2002, according to the Urban Institute, including:
4,700 older Americans;
5,500 people with disabilities; and
31,000 children and their families.
The Republican proposal would force Nebraska to eliminate coverage for about 4,200
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 53% of the 15,200
nursing home residents in Nebraska. Medicaid also serves about 4,900 older Americans and
people with disabilities using home care in Nebraska. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Nebraska to eliminate coverage for 23,100 children
in 2002.* Currently, 14% of the children in Nebraska rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 74,000 children in Nebraska.
Nebraska could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 40% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEVADA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Nevada would
lose $516 million over the seven years, a 29% reduction in 2002 alone. Even if Nevada
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 26,000 people in 2002, according to the Urban Institute, including:
2,900 older Americans;
4,100 people with disabilities; and
19,000 children and their families.
The Republican proposal would force Nevada to eliminate coverage for about 1,800
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 65% of the 2,700
nursing home residents in Nevada. Medicaid also serves about 2,600 older Americans and
people with disabilities using home care in Nevada. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Nevada to eliminate coverage for 12,900 children in
2002.* Currently, 9% of the children in Nevada rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 46,000 children in Nevada.
Nevada could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 29% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEW HAMPSHIRE
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New Hampshire
would lose $51 million over the seven years, a 6% reduction in 2002 alone. Even if New
Hampshire could absorb half of the cuts by reducing services and provider payments, it would
still have to eliminate coverage for 1,100 people in 2002, according to the Urban Institute.
The Republican proposal would force New Hampshire to eliminate coverage for people
needing long-term care in 2002.* Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 72% of the 5,700 nursing
home residents in New Hampshire. Medicaid also serves about 4,800 older Americans and
people with disabilities using home care in New Hampshire. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average of $38,000
per year nationally.
The Republican proposal would force New Hampshire to eliminate coverage for children
in 2002. * Currently, 13% of the children in New Hampshire rely on Medicaid for their basic
health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case
of emergencies for about 41,000 children in New Hampshire.
New Hampshire could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 6% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
Note: Due to data limitations, specific estimates for New Hampshire are not available.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEW JERSEY
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New Jersey would
lose $4 billion over the seven years, a 23% reduction in 2002 alone. Even if New Jersey
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 166,000 people in 2002, according to the Urban Institute, including:
15,300 older Americans;
29,000 people with disabilities; and
121,600 children and their families.
The Republican proposal would force New Jersey to eliminate coverage for about 16,700
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 69% of the 36,300
nursing home residents in New Jersey. Medicaid also serves about 39,200 older Americans
and people with disabilities using home care in New Jersey. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force New Jersey to eliminate coverage for 79,600
children in 2002.* Currently, 17% of the children in New Jersey rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 364,000 children in New Jersey.
New Jersey could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 23% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEW MEXICO
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New Mexico
would lose $1 billion over the seven years, a 34% reduction in 2002 alone. Even if New
Mexico could absorb half of the cuts by reducing services and provider payments, it would
still have to eliminate coverage for 80,000 people in 2002, according to the Urban Institute,
including:
8,000 older Americans;
17,100 people with disabilities; and
55,300 children and their families.
The Republican proposal would force New Mexico to eliminate coverage for about 4,200
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 72% of the 5,700
nursing home residents in New Mexico. Medicaid also serves about 5,100 older Americans
and people with disabilities using home care in New Mexico. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average of $38,000
per year nationally.
The Republican proposal would force New Mexico to eliminate coverage for 37,500
children in 2002. Currently, 17% of the children in New Mexico rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 152,000 children in New Mexico.
New Mexico could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 91% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NEW YORK
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. New York would
lose $19 billion over the seven years, a 27% reduction in 2002 alone. Even if New York
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 645,000 people in 2002, according to the Urban Institute, including:
66,400 older Americans;
100,400 people with disabilities; and
478,200 children and their families.
The Republican proposal would force New York to eliminate coverage for about 71,300
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 79% of the 84,500
nursing home residents in New York. Medicaid also serves about 241,800 older Americans
and people with disabilities using home care in New York. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force New York to eliminate coverage for 343,700
children in 2002. Currently, 25% of the children in New York rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 1,300,000 children in New York.
New York could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 27% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NORTH CAROLINA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. North Carolina
would lose $7 billion over the seven years, a 34% reduction in 2002 alone. Even if North
Carolina could absorb half of the cuts by reducing services and provider payments, it would
still have to eliminate coverage for 455,000 people in 2002, according to the Urban Institute,
including:
79,300 older Americans;
64,000 people with disabilities; and
312,300 children and their families.
The Republican proposal would force North Carolina to eliminate coverage for about
40,900 people needing long-term care in 2002.* Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers 76% of the
31,600 nursing home residents in North Carolina. Medicaid also serves about 31,300 older
Americans and people with disabilities using home care in North Carolina. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
The Republican proposal would force North Carolina to eliminate coverage for 204,600
children in 2002.* Currently, 19% of the children in North Carolina rely on Medicaid for
their basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive
care in case of emergencies for about 491,000 children in North Carolina.
North Carolina could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 62% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
NORTH DAKOTA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. North Dakota
would lose $382 million over the seven years, a 26% reduction in 2002 alone. Even if
North Dakota could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 18,000 people in 2002, according to the Urban
Institute, including:
2,700 older Americans;
2,300 people with disabilities; and
12,600 children and their families.
The Republican proposal would force North Dakota to eliminate coverage for about 2,300
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 57% of the 6,700
nursing home residents in North Dakota. Medicaid also serves about 3,600 older Americans
and people with disabilities using home care in North Dakota. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average of $38,000
per year nationally.
The Republican proposal would force North Dakota to eliminate coverage for 8,800
children in 2002.* Currently, 12% of the children in North Dakota rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 27,000 children in North Dakota.
North Dakota could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 58% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
OHIO
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Ohio would lose
$7 billion over the seven years, a 28% reduction in 2002 alone. Even if Ohio could absorb
half of the cuts by reducing services and provider payments, it would still have to eliminate
coverage for 292,000 people in 2002, according to the Urban Institute, including:
32,200 older Americans;
50,100 people with disabilities; and
209,800 children and their families.
The Republican proposal would force Ohio to eliminate coverage for about 28,000 people
needing long-term care in 2002. Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 69% of the 70,600
nursing home residents in Ohio. Medicaid also serves about 51,500 older Americans and
people with disabilities using home care in Ohio. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Ohio to eliminate coverage for 143,100 children in
2002. * Currently, 20% of the children in Ohio rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 785,000 children in Ohio.
Ohio could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 43% in 2002 -- by raising property or sales taxes, or cutting other
critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
OKLAHOMA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Oklahoma would
lose $2 billion over the seven years, a 31% reduction in 2002 alone. Even if Oklahoma
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 125,000 people in 2002, according to the Urban Institute, including:
14,000 older Americans;
16,400 people with disabilities; and
94,200 children and their families.
The Republican proposal would force Oklahoma to eliminate coverage for about 3,700
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 66% of the 21,900
nursing home residents in Oklahoma. Medicaid also serves about 12,300 older Americans and
people with disabilities using home care in Oklahoma. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Oklahoma to eliminate coverage for 65,800 children
in 2002.* Currently, 15% of the children in Oklahoma rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 198,000 children in Oklahoma.
Oklahoma could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 72% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
OREGON
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Oregon would
lose $2 billion over the seven years, a 31% reduction in 2002 alone. Even if Oregon could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 118,000 people in 2002, according to the Urban Institute, including:
8,900 older Americans;
15,400 people with disabilities; and
94,100 children and their families.
The Republican proposal would force Oregon to eliminate coverage for about 8,600
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 61% of the 11,300
nursing home residents in Oregon. Medicaid also serves about 25,200 older Americans and
people with disabilities using home care in Oregon. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Oregon to eliminate coverage for 62,700 children in
2002.* Currently, 13% of the children in Oregon rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 172,000 children in Oregon.
Oregon could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 49% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
PENNSYLVANIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Pennsylvania
would lose $6 billion over the seven years, a 27% reduction in 2002 alone. Even if
Pennsylvania could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 308,00 people in 2002, according to the Urban
Institute, including:
31,600 older Americans;
67,300 people with disabilities; and
209,400 children and their families.
The Republican proposal would force Pennsylvania to eliminate coverage for about
22,200 people needing long-term care in 2002.* Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers 64% of the
75,700 nursing home residents in Pennsylvania. Medicaid also serves about 22,300 older
Americans and people with disabilities using home care in Pennsylvania. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
The Republican proposal would force Pennsylvania to eliminate coverage for 150,800
children in 2002. Currently, 18% of the children in Pennsylvania rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 581,000 children in Pennsylvania.
Pennsylvania could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 30% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
RHODE ISLAND
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Rhode Island
would lose $861 million over the seven years, a 26% reduction in 2002 alone. Even if
Rhode Island could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 51,000 people in 2002, according to the Urban
Institute, including:
7,800 older Americans;
11,200 people with disabilities; and
32,100 children and their families.
The Republican proposal would force Rhode Island to eliminate coverage for about
12,000 people needing long-term care in 2002.* Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers 75% of the
7,200 nursing home residents in Rhode Island. Medicaid also serves about 12,000 older
Americans and people with disabilities using home care in Rhode Island. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
The Republican proposal would force Rhode Island to eliminate coverage for 21,600
children in 2002. Currently, 23% of the children in Rhode Island rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 44,000 children in Rhode Island.
Rhode Island could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 31% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
SOUTH CAROLINA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. South Carolina
would lose $2 billion over the seven years, a 24% reduction in 2002 alone. Even if South
Carolina could absorb half of the cuts by reducing services and provider payments, it would
still have to eliminate coverage for 149,000 people in 2002, according to the Urban Institute,
including:
21,300 older Americans;
24,700 people with disabilities; and
102,600 children and their families.
The Republican proposal would force South Carolina to eliminate coverage for about
7,800 people needing long-term care in 2002. Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers 74% of the
12,400 nursing home residents in South Carolina. Medicaid also serves about 13,100 older
Americans and people with disabilities using home care in South Carolina. Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
The Republican proposal would force South Carolina to eliminate coverage for 73,300
children in 2002.* Currently, 24% of the children in South Carolina rely on Medicaid for
their basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive
care in case of emergencies for about 232,000 children in South Carolina.
South Carolina could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 59% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
SOUTH DAKOTA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. South Dakota
would lose $396 million over the seven years, a 28% reduction in 2002 alone. Even if
South Dakota could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 19,000 people in 2002, according to the Urban
Institute, including:
2,300 older Americans;
3,300 people with disabilities; and
13,300 children and their families.
The Republican proposal would force South Dakota to eliminate coverage for about 2,100
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 56% of the 7,600
nursing home residents in South Dakota. Medicaid also serves about 2,200 older Americans
and people with disabilities using home care in South Dakota. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average of $38,000
per year nationally.
The Republican proposal would force South Dakota to eliminate coverage for 9,600
children in 2002. Currently, 15% of the children in South Dakota rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 37,000 children in South Dakota.
South Dakota could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 56% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
TENNESSEE
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Tennessee would
lose $5 billion over the seven years, a 32% reduction in 2002 alone. Even if Tennessee
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 246,000 people in 2002, according to the Urban Institute, including:
27,800 older Americans;
61,000 people with disabilities; and
157,000 children and their families.
The Republican proposal would force Tennessee to eliminate coverage for about 5,800
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 77% of the 31,800
nursing home residents in Tennessee. Medicaid also serves about 9,300 older Americans and
people with disabilities using home care in Tennessee. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Tennessee to eliminate coverage for 112,000
children in 2002. Currently, 27% of the children in Tennessee rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 452,000 children in Tennessee.
Tennessee could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 61% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
TEXAS
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Texas would lose
$11 billion over the seven years, a 29% reduction in 2002 alone. Even if Texas could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 687,000 people in 2002, according to the Urban Institute, including:
66,800 older Americans;
68,500 people with disabilities; and
551,600 children and their families.
The Republican proposal would force Texas to eliminate coverage for about 43,100 people
needing long-term care in 2002.' Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 76% of the 63,700
nursing home residents in Texas. Medicaid also serves about 85,900 older Americans and
people with disabilities using home care in Texas. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Texas to eliminate coverage for 394,100 children in
2002.* Currently, 20% of the children in Texas rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 1,407,000 children in Texas.
Texas could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 48% in 2002 -- by raising property or sales taxes, or cutting other
critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
UTAH
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Utah would lose
$1 billion over the seven years, a 31% reduction in 2002 alone. Even if Utah could absorb
half of the cuts by reducing services and provider payments, it would still have to eliminate
coverage for 53,000 people in 2002, according to the Urban Institute, including:
3,200 older Americans;
6,200 people with disabilities; and
43,800 children and their families.
The Republican proposal would force Utah to eliminate coverage for about 3,100 people
needing long-term care in 2002.* Medicaid is the largest insurer of long-term care for all
Americans, including the middle class. Currently, Medicaid covers 65% of the 5,500 nursing
home residents in Utah. Medicaid also serves about 3,200 older Americans and people with
disabilities using home care in Utah. Without Medicaid, families of the elderly and disabled
could not afford nursing home care that costs an average of $38,000 per year nationally.
The Republican proposal would force Utah to eliminate coverage for 29,000 children in
2002. * Currently, 8% of the children in Utah rely on Medicaid for their basic health needs.
Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 86,000 children in Utah.
Utah could avoid these difficult choices forced by the Republican proposal only by increasing
its Medicaid spending by 86% in 2002 -- by raising property or sales taxes, or cutting other
critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
VERMONT
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Vermont would
lose $318 million over the seven years, a 27% reduction in 2002 alone. Even if Vermont
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 20,000 people in 2002, according to the Urban Institute, including:
2,400 older Americans;
3,500 people with disabilities; and
14,200 children and their families.
The Republican proposal would force Vermont to eliminate coverage for about 1,900
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 68% of the 3,300
nursing home residents in Vermont. Medicaid also serves about 4,600 older Americans and
people with disabilities using home care in Vermont. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Vermont to eliminate coverage for 9,000 children in
2002.* Currently, 18% of the children in Vermont rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 47,000 children in Vermont.
Vermont could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 42% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
VIRGINIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Virginia would
lose $3 billion over the seven years, a 33% reduction in 2002 alone. Even if Virginia could
absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 236,000 people in 2002, according to the Urban Institute, including:
32,400 older Americans;
36,400 people with disabilities; and
167,100 children and their families.
The Republican proposal would force Virginia to eliminate coverage for about 17,800
people needing long-term care in 2002.* Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 70% of the 25,400
nursing home residents in Virginia. Medicaid also serves about 17,600 older Americans and
people with disabilities using home care in Virginia. Without Medicaid, families of the elderly
and disabled could not afford nursing home care that costs an average of $38,000 per year
nationally.
The Republican proposal would force Virginia to eliminate coverage for 117,000 children
in 2002.* Currently, 14% of the children in Virginia rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 334,000 children in Virginia.
Virginia could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 35% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
WASHINGTON
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Washington
would lose $4 billion over the seven years, a 31% reduction in 2002 alone. Even if
Washington could absorb half of the cuts by reducing services and provider payments, it
would still have to eliminate coverage for 183,000 people in 2002, according to the Urban
Institute, including:
12,900 older Americans;
29,500 people with disabilities; and
140,500 children and their families.
The Republican proposal would force Washington to eliminate coverage for about 8,200
people needing long-term care in 2002.' Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 67% of the 23,600
nursing home residents in Washington. Medicaid also serves about 4,300 older Americans
and people with disabilities using home care in Washington. Without Medicaid, families of
the elderly and disabled could not afford nursing home care that costs an average of $38,000
per year nationally.
The Republican proposal would force Washington to eliminate coverage for 91,200
children in 2002. * Currently, 12% of the children in Washington rely on Medicaid for their
basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive care in
case of emergencies for about 328,000 children in Washington.
Washington could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 31% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
WEST VIRGINIA
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. West Virginia
would lose $3 billion over the seven years, a 35% reduction in 2002 alone. Even if West
Virginia could absorb half of the cuts by reducing services and provider payments, it would
still have to eliminate coverage for 140,000 people in 2002, according to the Urban Institute,
including:
13,200 older Americans;
26,100 people with disabilities; and
100,300 children and their families.
The Republican proposal would force West Virginia to eliminate coverage for about
5,400 people needing long-term care in 2002.* Medicaid is the largest insurer of long-term
care for all Americans, including the middle class. Currently, Medicaid covers 75% of the
6,300 nursing home residents in West Virginia Medicaid also serves about 3,300 older
Americans and people with disabilities using home care in West Virginia Without Medicaid,
families of the elderly and disabled could not afford nursing home care that costs an average of
$38,000 per year nationally.
The Republican proposal would force West Virginia to eliminate coverage for 60,200
children in 2002.* Currently, 24% of the children in West Virginia rely on Medicaid for
their basic health needs. Medicaid pays for immunizations, regular check-ups, and intensive
care in case of emergencies for about 161,000 children in West Virginia
West Virginia could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 97% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
*
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
WISCONSIN
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Wisconsin would
lose $3 billion over the seven years, a 29% reduction in 2002 alone. Even if Wisconsin
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 94,000 people in 2002, according to the Urban Institute, including:
12,800 older Americans;
23,000 people with disabilities; and
58,000 children and their families.
The Republican proposal would force Wisconsin to eliminate coverage for about 11,300
people needing long-term care in 2002.' Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 68% of the 43,100
nursing home residents in Wisconsin. Medicaid also serves about 13,200 older Americans and
people with disabilities using home care in Wisconsin. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Wisconsin to eliminate coverage for 42,600 children
in 2002.* Currently, 15% of the children in Wisconsin rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 141,000 children in Wisconsin.
Wisconsin could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 43% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
THE WHITE HOUSE
Office of Media Affairs
September 14, 1995
Contact: 202/456-7150
WYOMING
The Republican Budget Resolution Conference Agreement:
Medicaid Cuts Will Force States to Reduce Health Coverage
Republican's Proposal: Reduces Medicaid Payments to States by 30% in 2002
Republicans are proposing to cut more than $182 billion from Federal Medicaid spending
between 1996 and 2002: a cut of 20% over seven years and 30% in 2002. Wyoming would
lose $245 million over the seven years, a 30% reduction in 2002 alone. Even if Wyoming
could absorb half of the cuts by reducing services and provider payments, it would still have to
eliminate coverage for 15,000 people in 2002, according to the Urban Institute, including:
1,000 older Americans;
1,700 people with disabilities; and
12,200 children and their families.
The Republican proposal would force Wyoming to eliminate coverage for about 1,600
people needing long-term care in 2002. Medicaid is the largest insurer of long-term care
for all Americans, including the middle class. Currently, Medicaid covers 66% of the 1,700
nursing home residents in Wyoming. Medicaid also serves about 3,300 older Americans and
people with disabilities using home care in Wyoming. Without Medicaid, families of the
elderly and disabled could not afford nursing home care that costs an average of $38,000 per
year nationally.
The Republican proposal would force Wyoming to eliminate coverage for 8,500 children
in 2002.' Currently, 13% of the children in Wyoming rely on Medicaid for their basic health
needs. Medicaid pays for immunizations, regular check-ups, and intensive care in case of
emergencies for about 26,000 children in Wyoming.
Wyoming could avoid these difficult choices forced by the Republican proposal only by
increasing its Medicaid spending by 45% in 2002 -- by raising property or sales taxes, or
cutting other critical state spending.
The President's Balanced Budget Proposal
The President's proposal saves $54 billion over seven years from Medicaid, less than one-third
the Republican cut and still a significant contribution toward deficit reduction. The President's
Medicaid policy produces savings by reducing and retargetting disproportionate share
payments, increasing state flexibility, and limiting the growth in Federal Medicaid spending
per recipient. This policy constrains Federal spending but allows states to respond to
unexpected changes in the number of people covered. It does not put states at risk and
dismantle a program that has served as a critical safety net -- as would happen under the
Republican proposal.
U.S. Department of Health & Human Services estimates based on the Urban Institute data; numbers may not sum to totals due to rounding.
The Governors'
Medicaid Proposal
CENTER ON BUDGET
AND POLICY PRIORITIES
March 1996
The Governors'
Medicaid Proposal
Richard Kogan
Cindy Mann
CENTER ON BUDGET
AND POLICY PRIORITIES
Washington, D.C.
The Center on Budget and Policy Priorities, located in Washington, D.C., is a non-profit, tax-
exempt organization that studies government spending and the programs and public policy issues that
have an impact on low-income Americans. The Center is supported by foundations, individual
contributors, and publications sales.
Board of Directors
John R. Kramer, Chair
Dean, Tulane Law School
Henry J. Aaron
James O. Gibson
Susan Sechler
Brookings Institution
Urban Institute
Aspen Institute
Rebecca M. Blank
Richard P. Nathan
Juan Sepulveda, Jr.
Southwest Voter
Northwestern University
Nelson A. Rockefeller Institute
Research Institute
Marian Wright Edelman
Marion Pines
William Julius Wilson
Children's Defense Fund
Institute for Policy Studies
University of Chicago
Johns Hopkins University
David de Ferranti
William S. Woodside
Robert D. Reischauer
The World Bank
Sky Chefs, Inc.
Brookings Institute
Arthur S. Flemming
Audrey Rowe
Former Secretary of Health,
National Urban League
Education and Welfare
Isaac Shapiro
Robert Greenstein
Iris J. Lav
Associate Director
Executive Director
Associate Director
Authors
Cindy Mann is a senior policy analyst and Director of the State Low-Income Initiatives Project at
the Center on Budget and Policy Priorities. She has worked on Medicaid and health care policy issues for
more than a decade.
Richard Kogan is a Senior Fellow at the Center on Budget and Policy Priorities, former Director of
Special Studies for the House Budget Committee, and a noted expert on the federal budget.
March 1996
Center on Budget and Policy Priorities
777 N. Capitol Street, NE, Suite 705
Washington, D.C. 20002
(202) 408-1080
ISBN 1-57291-012-7
Contents
Acknowledgments
V
I.
Overview
1
II.
The Limits of Coverage Guarantees
5
III.
Effects of the Governors' Funding Mechanisms
13
IV.
Summary and Recommendations
31
Appendices
A
Alternative Interpretations Produce Different Problems
37
B
Data and Methodology
41
C
Federal Medical Assistance Percentages
43
Tables
Table 1
The Effect of Reducing the State Matching Rate
17
Table 2
Capping and Cutting Federal Payments; Cutting the State Share
18
Table 3
Potential Reductions in Medicaid Funding
20
Table 4
Potential Reductions in Medicaid Funding - Then and Now
20
Acknowledgments
The authors wish to thank their colleagues at the Center on Budget and Policy
Priorities who contributed to this report. Robert Greenstein and Isaac Shapiro
offered analytical and editorial advice. Betty Hitchcock and Wendy Burnette
prepared the document for publication.
The Center on Budget and Policy Priorities thanks the Carnegie Foundation
for making this work possible.
The authors claim sole responsibility for the contents of the report.
V
I.
Overview
The Medicaid proposal adopted by the National Governors' Association makes
some improvements in the Medicaid block grant approved by Congress but also has
many troubling elements. By creating incentives for states to withdraw large amounts
of state funding, the plan could result in total program reductions at least three times as
deep as the federal reductions by themselves. In addition, the plan leaves some groups
of poor children and adults without a guarantee of coverage and grants states sweeping
discretion to scale back the health services that Medicaid covers. In combination, the
increased incentive for states to withdraw Medicaid funding and the broad discretion
granted to states over eligibility and benefits is likely to lead both to a substantial
reduction in the number of people insured and to erosion in the health services covered
for many of those who remain insured.
To begin with, the governors' plan would eliminate the federal guarantee of
coverage to substantial numbers of people now protected by the program. Most of the
basic decisions concerning coverage for poor children over age 12, low-income parents,
and disabled people would be left to state discretion.
States also would decide the amount, duration, and scope of the health services
covered for persons insured under the program, without any meaningful federal
standards or guidelines. State discretion over the health services covered would be so
vast as to allow states, for example, to deny vision and hearing care to children or to
restrict coverage of hospital care for people with chronic illnesses to only a few days
per month. In other examples, a state could decline to cover all necessary laboratory
tests for an elderly individual who has suffered a stroke or to pay for the cost of
medical equipment such as a walker.
The removal of federal standards in these areas is especially significant in light
of other parts of the governors' plan that would allow states to reduce state Medicaid
1
funding sharply. States would be able to withdraw $182 billion to $214 billion in state
funds over seven years without affecting the level of federal Medicaid funding they
receive. By contrast, under current law states cannot withdraw state funding without
triggering at least a dollar-for-dollar reduction in federal funds. The ability of states to
scale back Medicaid eligibility and benefits and reap 100 percent of the savings makes
state actions to reduce the health insurance that Medicaid provides more likely.
Aggravating this situation are aspects of the governors' proposal that would
make legal the types of sham financing schemes that a growing number of states were
using until Congress and the Bush and Clinton Administrations outlawed them in the
early 1990s. These financing mechanisms would enable states to meet state matching
requirements without actually providing the requisite amount of state funds. States
taking advantage of these financing gimmicks in coming years could reduce state
Medicaid contributions still further without jeopardizing federal funds. As a
consequence, the potential reduction in state funding under the governors' proposal
could be even greater than $182 billion to $214 billion.
The funding structure the governors' plan would establish also has other
shortcomings. Under the plan, if enrollment of certain groups of beneficiaries
increased above projected levels because of such factors as population growth or an
economic downturn, states could receive additional federal payments from an
"umbrella" fund. This fund reflects the laudable goal of creating a financing system in
which federal dollars "follow the people." But there are problems with the fund's
design. For example, the umbrella payments, as well as the basic block grant
payments, would not respond to increases in inflation that cause state health care costs
to be higher than anticipated.
In addition, the governors' proposal is structured in a manner that would allow
states to "game" the system and access federal umbrella funds in unwarranted
circumstances. This feature of the governors' proposal is likely to reduce federal
savings; partly because of it, the level of federal savings that would result from the
proposal is likely to be lower than the level of savings that either the Administration's
proposal or the current Republican budget proposal would generate.
Another problem with the governors' plan is that it ends basic legal protections
which now are part of Medicaid. The plan would repeal current Medicaid law without
providing any assurance that provisions of current law banning providers from billing
Medicaid patients, protecting beneficiaries from unaffordable cost-sharing
requirements, and prohibiting discrimination against certain groups of beneficiaries
based on their medical condition would be maintained. In addition, the plan makes
clear that neither beneficiaries nor providers could turn to federal courts to enforce any
rights the new federal law might provide.
2
Medicaid is a complex program under which financing provisions and coverage
and benefit rules interact in ways that determine whether vulnerable people are
assured adequate health care coverage. It is possible to broaden state flexibility
substantially and achieve significant savings without weakening the health care safety
net if care is taken to balance various interests and goals. But the governors' plan does
not achieve such a balance. It primarily serves the interests of state governments by
guaranteeing states a certain level of federal payments, allowing states to withdraw
large amounts of state funds without losing any of this federal money, letting states
scale back Medicaid eligibility and benefits, and denying recipients and providers
access to federal court.
The likelihood that a substantial number of states would take advantage of
opportunities to withdraw state funds, coupled with the great latitude states would
have to scale back Medicaid benefit packages and to end coverage for certain groups of
beneficiaries, creates a large risk that health insurance for vulnerable populations
would be materially weakened. Under the plan, millions of poor children, parents, and
disabled and elderly people are likely either to become uninsured or inadequately
insured.
3
II.
The Limits of the Coverage Guarantees
The following groups of people would be guaranteed coverage for some health
care services under the governors' plan:
Pregnant women and children under age six with incomes below 133
percent of the federal poverty line;
Children aged six through 12 with incomes below 100 percent of the
federal poverty line;
Elderly people with incomes and assets below the Supplemental Security
Income standards; and
Medicare beneficiaries with incomes below 100 percent of the federal
poverty line. These beneficiaries would receive coverage for payment of
Medicare copayments, deductibles and premiums.
Several other groups of people now guaranteed coverage under Medicaid,
however, would lose that guarantee.
Poor Children over Age 12
Under changes enacted in 1990 with bipartisan support and signed into law by
President Bush, Medicaid coverage for older poor children is being phased in so that by
2002, all poor children under age 19 will be covered. The governors' proposal would
repeal the coverage guarantee being phased in for poor children over age 12.
Coverage of older poor children would be optional with the states (except for
some children with ties to the welfare system; see the next section). As a result, states
could deny coverage to large numbers of poor children over age 12. For example, they
5
could limit coverage to children below a certain age (such as 14) or to children with
incomes below some fraction of the poverty line.
The principal group that would lose assurance of coverage consists of poor
children over 12 whose parents work at low-wage jobs that do not offer health
insurance for dependents. Three million poor children over age 12 in non-welfare
families could be denied coverage because of this repeal.
Another feature of the governors' plan makes it likely that many states will think
twice before extending coverage to poor children over age 12. Under the plan, an
umbrella fund would be created to provide additional federal payments to a state when
the number of Medicaid beneficiaries in the state exceeds the number forecast at the
time of the legislation's enactment. But the umbrella fund has a gap - children over 12
whom a state opted to cover would not be counted when a state's umbrella funding
level is determined.
This means that whether or not a state elects to cover children over 12 in
working poor families has no effect on the level of federal Medicaid a state receives. Both the
"basic grant" the state would receive and umbrella funding it would get would be
unaffected by whether a state chooses to cover none, some, or all of these poor children.
Moreover, if a state decided to cover working poor children and enrollment of
these children then exceeded expectations - perhaps because child poverty rose in the
state - the umbrella fund would offer no help. States that chose to enroll poor
children over age 12 consequently would assume all of the risk of higher-than-
anticipated enrollment themselves. This would likely discourage states from picking
up this option.
The exclusion of these children from the umbrella funding mechanism stands in
contrast to the treatment of other groups. The umbrella fund would cover beneficiary
growth among groups of elderly and disabled people that states elected to cover, as
well as among groups of elderly and disabled people that states were required to cover.
For children and pregnant women, however, the umbrella fund would cover only those
whom states were mandated to cover. Groups such as children over age 12 in working
poor families would be left out.
Children and Parents Who Receive AFDC
The problem caused by eliminating the coverage guarantee being phased in for
poor children over age 12 is compounded by the changes proposed for families that
qualify for Medicaid based on their receipt of AFDC benefits. Under current law, all
children and parents who receive AFDC are automatically eligible for Medicaid. Under
the governors' plan, however, states could disenroll many of these children and
parents. While a state could opt to continue covering children and parents whose
6
income and assets are below the state's current AFDC standards, the state could instead
elect either of the following two options:
to restrict Medicaid eligibility in states in which the AFDC eligibility
criteria are above the national average by lowering the state's Medicaid
income and asset limits to the current national average limits in AFDC.
The current national average AFDC income limit for a family of three is
$399 per month, or just 38 percent of the poverty line. More than half of
the children over age 12 who receive Medicaid based on AFDC eligibility
- 53 percent - live in states with AFDC income limits above the national
average; or
to cover only those parents and children who qualify for the new program
a state creates under its welfare block grant. These programs are likely to
have much more restrictive criteria than the current AFDC program in
many states. Under the welfare block grant, states would have unlimited
discretion to restrict eligibility, and no federal minimum eligibility
standards would apply.
If most states adopted either of these latter two options, millions of children and
parents would lose Medicaid coverage. For example, in a state choosing the last option,
those parents and older children who would be ineligible for welfare due to time limits
or other restrictive welfare rules that a state adopted would lose Medicaid coverage.
Currently, four million parents and 1.5 million children receive Medicaid on the
basis of their eligibility for AFDC. (These 1.5 million children are in addition to the
three million children over age 12 in non-AFDC families who will be eligible for
Medicaid under current law when coverage guarantees for poor children are phased in
fully.)
People With Disabilities
Under the governors' proposal, there would be no federal definition of disability
and no minimum income or asset standards for persons with disabilities. A state could
limit coverage for disabled people in whatever way it saw fit.
For example, a state could limit coverage to people who reside in state
institutions or whose disabilities are life-threatening. States also could restrict
eligibility to disabled individuals with incomes well below the poverty line. States thus
could eliminate the current link for the disabled between Medicaid coverage and
eligibility for the Supplemental Security Income program. In some states, significant
numbers of low-income individuals sufficiently disabled to receive SSI could lose
Medicaid coverage.
7
States would have strong incentives to restrict eligibility for disabled people
since they are a rapidly growing and high-cost group to insure. The Congressional
Budget Office projects that under current law, the increase in disabled beneficiaries will
account for about 45 percent of the projected growth in overall Medicaid costs between
1995 and 2005.¹ Six million people are now enrolled in Medicaid because of their
disabilities.
The governors' proposal does contain a "set-aside" requirement that would
direct states to spend a certain percentage of their Medicaid funds on the disabled.² But
if states reduce overall Medicaid expenditures as the governors' proposal would allow
(see Chapter III), Medicaid resources devoted to the disabled in 2002 could be 38
percent to 43 percent below what is projected under current law.³ States could reduce
coverage for the disabled sharply and still meet the set-aside requirement.
A Guarantee of What?
While the governors' proposal guarantees coverage for certain categories of
people, it repeals virtually all federal standards relating to the health services that states
must cover under their Medicaid programs. Under the proposal, a state would have to
offer some hospital care, physician services, home health care, laboratory services, and
other specified benefits to people the state is required to cover.⁴ But all current rules on
the amount, duration, and scope of the health care services that must be covered would be
dropped.⁵
1
Statement of Joseph R. Antos, Assistant Director for Health and Human Resources, Congressional
Budget Office, before the U.S. House of Representatives Committee on Commerce, June 21, 1995.
2
The set-aside requirement equals "90 percent of the percentage of total medical assistance funds paid
in fiscal year 1995 for persons with disabilities." For example, if 28 percent of total Medicaid spending in a
state in fiscal year 1995 was devoted to the disabled, then in future years at least 25 percent (90 percent of
28 percent) of Medicaid spending in that state would have to be earmarked for the disabled. (This example
is used because in fiscal year 1995, some 28 percent of Medicaid dollars nationwide were spent on services
for the disabled.)
3
These percentages are consistent with reductions in overall state Medicaid funding of $182 billion to
$214 billion over seven years, as discussed in the state funding section.
4
Under current law, certain benefits are considered mandatory while others are optional. States
currently must provide all categories of persons covered under the program with all mandatory benefits.
By contrast, under the governors' plan, states would only have to provide the categories of people they are
required to enroll with the mandatory categories of services (i.e., some hospital care, physician services,
etc.) There would be no federal benefit rules applied to optional categories of people, such as poor children
over age 12.
5
States already have considerable flexibility in defining benefit coverage as long as "Each service (is)
(continued...)
8
People guaranteed coverage under the plan thus may find the guarantee a
hollow one. All of the rules regarding what hospital care, physician services or other
services must be covered would be left up to the states, with no minimum federal
standards. A state could choose to offer only a skeletal benefit package to any or all
groups of beneficiaries.
A state seeking to reduce state expenditures for Medicaid could impose annual
or lifetime limits on hospital utilization or limit coverage for hospital care to only a few
days per month. In an extreme case, a state could guarantee only several days of
hospital care in the event of a heart attack. A state also could limit expenditures for
prescription medications to a level below what a significant number of chronically ill or
disabled people need.⁶
If mid-year fiscal pressures arise, a state could scale back the health services it
covers for new applicants as compared to the services covered for the people already
enrolled in the program.⁷ Large differences among states in Medicaid benefit packages
almost certainly would emerge in the absence of federal minimum standards.
This, in turn, would increase the risks of the "race to the bottom" about which
many analysts have warned. Without federal standards, policymakers in a state may
become concerned that having a more generous benefit package than neighboring
states will attract people from those states. As a result, major reductions in Medicaid
services by one state could trigger reductions by others, setting in motion a downward
spiral in the adequacy of the health care coverage that Medicaid provides.
The governors' proposal also would substantially modify current federal
requirements concerning the treatment services that must be made available to poor
children; it would restrict the rules governing the Early and Periodic Screening,
Diagnostic, and Treatment (EPSDT) component of Medicaid. Under current law,
children found to be suffering from a medical problem detected during a routine
screening must be provided with the treatment necessary to address the problem. The
governors' proposal would greatly scale back this treatment guarantee for children by
5 (...continued)
sufficient in amount, duration, and scope to reasonably achieve its purpose," 42 C.F.R. sec. 440.230(b).
Thus, under current law, services do not have be sufficient to meet every person's needs, but services must
be of sufficient amount, duration and scope to assure that most of the eligible people receive the amount of
services they need. State-imposed limits on services have been approved by HCFA and upheld by the
courts.
6
Currently, prescription medications are an optional service, although all states cover prescriptions for
most of their Medicaid beneficiaries. Even though the service is optional under current law, states electing
to provide this service must follow federal amount, scope and duration rules.
7
Maryland Governor Parris Glendening has already stated that this approach might be taken in
Maryland, projecting that managed care savings will not be sufficient to offset anticipated reductions in
federal Medicaid payments under a block grant. Maryland FY97 Budget, Budget Priorities, p. 20.
9
allowing states to provide only whatever level of treatment is otherwise available
under the state's Medicaid plan. Since there would no longer be any meaningful
federal rules governing the benefits provided under a state's plan, this proposed
change in EPSDT rules would leave poor children with serious medical problems
without assurance they would receive the treatment their physician recommends.
Without a guarantee of treatment, the EPSDT screening requirements that would be
retained in the governors' plan are likely to be of little value.
In addition, the plan could weaken the benefit coverage provided to poor
Medicare beneficiaries. Under current law, Medicaid pays the Medicare copayments,
premiums, and deductibles for those Medicare beneficiaries whose income is below the
poverty line.⁸ The governors' plan would weaken this coverage for low-income
Medicare beneficiaries by allowing states to limit payments for Medicare copayments
to the rates the state pays under Medicaid. For example, if a Medicare beneficiary were
required to pay a 20 percent copayment on physician charges set at $5,000 based on
Medicare rates, and under Medicaid rates the physician charges were limited to $4,000,
Medicaid would cover only $800 of the $1,000 copayment (i.e., Medicaid would pay 20
percent of $4,000 rather than 20 percent of $5,000). It is unclear whether poor Medicare
beneficiaries would have to pay the difference between the state's Medicaid payment
and the Medicare charges (in this example, $200) or whether providers would be
expected to absorb the uncovered portion of their fees.
The Effects of Repealing Current Medicaid Law
The governors' plan calls for repealing the existing Medicaid statute (Title XIX of
the Social Security Act) without specifying those portions of current law that would be
retained. A wholesale repeal of Title XIX could have far-reaching consequences.
Provisions protecting beneficiaries from copayment and other cost-sharing
requirements they cannot afford could disappear. So could rules prohibiting providers
from billing Medicaid patients. A better course of action would be to review Title XIX
and eliminate, revise and simplify those provisions of the law that do not comport with
the changes that Congress wishes to make to accord states more flexibility.
Ban on Access to Federal Court
Finally, neither beneficiaries nor providers would be able to sue in federal court
to enforce any rights the new federal Medicaid law supposedly guarantees them.⁹ The
8 Medicaid also pays the premium costs, but not the copayment and deductible costs, for Medicare
beneficiaries between 100 percent and 120 percent of the poverty line.
9 The plan is silent as to whether it also would prohibit beneficiaries from relying on other federal laws,
such as the Americans with Disabilities Act or civil rights laws, to bring certain Medicaid claims into
(continued..)
10
elimination of the right to seek legal redress in federal court would be unprecedented;
no federally established program supported by billions of federal dollars is now
immune from suit in federal court. Without access to federal courts, the meaning of
federal law would be subject to the differing views of the courts of 50 states, and
important remedies that may not be available in state court could be lost.¹⁰
As a result, there are two reasons why the coverage guarantees in the governors'
proposal have less meaning than may initially appear to be the case. Those who are
guaranteed coverage are not guaranteed any type of minimum benefit package, and
they also are prohibited from bringing suit in federal court if a state violates the federal
coverage guarantee.
9 (...continued)
federal court.
10
If Medicaid law is revised to eliminate or substantially limit federal standards regarding provider
reimbursement rates, there will be much less litigation under federal Medicaid law in the future. In those
limited areas where federal rights would be maintained, access to federal courts should be maintained as
well.
11
III.
Effects of the Governors' Funding Mechanisms
This chapter examines the funding structure of the governors' proposal. One
important aspect of the governors' proposal is its inclusion of additional federal
Medicaid payments to states with larger-than-anticipated Medicaid caseloads. This is a
significant improvement over the Medicaid bill Congress passed last fall, which would
have established fixed federal block grants that would not have been responsive to
unexpected changes in the location, number, or mix of Medicaid beneficiaries.
Nevertheless, there are a number of serious flaws with the governors' funding
structure.
1)
It could lead to very large reductions in state Medicaid funding,
producing substantial cutbacks in the Medicaid benefit package,
payments to providers, and/or Medicaid coverage. Reductions in state
Medicaid funding could be nearly three times as large as the reduction in
federal funding.
Such large reductions could result in decreased coverage for low-income
individuals. They also could result in shifts in costs to local governments
that operate city or county hospitals or clinics and to employers and
employees who pay premiums for private health insurance policies.
2)
States would again be permitted to use discredited - and currently
illegal - financing schemes to lessen state contributions to Medicaid.
3)
If Medicaid caseloads exceeded expectations in a state or nationally, the
federal government would bear a fair share of the added Medicaid costs.
But if caseloads fell below expectations, states would collect much or all
13
of the savings, with the federal government failing to receive a fair share
of the reduction in cost.
4)
States would be able to "game the system," limiting the efficacy of the
proposed caps on federal Medicaid expenditures and enriching their
treasuries at federal expense.
These four deficiencies suggest that the funding structure of the governors'
proposal is designed to serve state fiscal needs more than federal fiscal needs and also
to protect states against unexpected fiscal problems more than to protect poor children,
parents, and elderly and disabled people against unexpected health problems. There
also is a fifth shortcoming with the financing aspects of the governors' proposal:
5)
The caps it would place on federal Medicaid funding would not respond
to unexpected changes in the general inflation rate. As a result, the caps
would squeeze states too hard if the general inflation rate turned out to be
higher than is currently forecast and would treat states too generously
(and cost the federal government too much) if inflation was lower than
forecast.
Current Matching Requirements
Under current law, Medicaid is funded jointly by the federal and state
governments. The federal government pays each state a fixed percentage of its total
Medicaid costs, and the state pays the rest. The federal percentage is called the Federal
Medical Assistance Percentage, or FMAP.
The FMAP is based on state per-capita income; the poorer a state, the higher the
federal share of Medicaid costs and the lower the state share. The state shares of
Medicaid costs range from 21 percent in the poorest state (Mississippi) to 50 percent in
the 12 states with the highest per-capita income. On average, states pay 43 percent of
Medicaid costs.
Currently, if Medicaid costs rise in a state for any reason - for example, if more
people enroll in Medicaid or the rates paid to health care providers increase - the
federal government pays its share (at least 50 percent) of the additional costs.
Similarly, if states reduce Medicaid expenditures, the federal government receives its
share (again, at least 50 percent) of the resulting savings.
The Governors' Proposal
The governors' proposal would change current law in three fundamental ways.
14
The proposal would set a ceiling or "cap" on federal Medicaid payments
for each state. (See box at bottom of the page.) Once federal payments
reached the ceiling, the federal government would cease providing funds,
and a state would bear in full any additional costs incurred. The federal
cap would be set at a level below what federal Medicaid expenditures are
projected to be under current law. Therefore, the amount of matching
funds that a state would have to put up to secure its maximum federal
funding allotment also would be less than the amount the state would be
expected to contribute under current law. As a consequence, states could
reduce projected state Medicaid contributions without affecting the
amount of federal funds they receive.
In addition - and of particular importance - the NGA proposal would
reduce state matching percentages for at least 25 states. All states that
currently pay more than 40 percent of Medicaid costs would have to pay at
most 40 percent of such costs.
For example, a state now bearing 50 percent of Medicaid costs would
instead have to pay 40 percent of such costs. This means a state that has a
50 percent matching rate and now provides $3 in state funds for each $3
in federal Medicaid payments it receives would instead have a 40 percent
match rate and be required to provide just $2 in state funds for each $3 in
federal funds.
The Cap on Federal Medicaid Payments
The proposed cap on federal payments to a state would equal the sum of: a) the "basic
grant" to the state (which would equal federal Medicaid expenditures in the state in a base
year, increased in accordance with a growth formula written into the statute); and
b) "umbrella" payments made to a state to cover unanticipated caseload growth (that is,
caseload growth that was not anticipated and not built into the growth formula used to
determine the state's basic grant).
The federal umbrella payments would be paid to states on a per beneficiary basis.
They would be open-ended in that no limit would be placed on the number of additional
beneficiaries for whom umbrella payments would be made. But in another sense, the
umbrella payments would be capped - the amount of the umbrella payment for each
additional beneficiary served would be determined by a formula written into the statute, not
by the state's actual costs in serving the beneficiary. The umbrella payments would not cover
unlimited costs for the additional beneficiaries.
15
A state whose matching percentage is reduced from 50 percent to 40
percent thus could reduce its state contribution by one-third without such
action having any effect on the level of federal funding it secures. (The
NGA proposal is unclear on whether matching rates also would be
reduced for states whose current matching rates are below 40 percent. The
Medicaid part of the budget reconciliation bill that Congress passed last
fall would have lowered the matching rate requirement for many of those
states as well.)¹¹
Third, the governors' proposal would make legal the sham financing
schemes that some states used in past years to secure federal Medicaid
funds without actually providing state matching funds. These schemes
were outlawed by federal legislation enacted during the Bush
Administration.
These dubious financing mechanisms include schemes under which a
state could, for example, collect $100 million from hospitals through a
"provider tax," return the $100 million to the hospitals as Medicaid
"disproportionate share hospital" payments, and use the $100 million in
payments to hospitals to secure $50 million in federal matching funds.
Making such financing schemes legal again would enable states to appear
to meet state matching requirements without really spending the requisite
amount of state money on Medicaid benefits.¹²
Potential Reductions in State Medicaid Funding
How deep could reductions in Medicaid funding be under the governors'
proposal? Several factors are at work here.
First, consider the effect of capping federal Medicaid payments. If federal
payments are capped, a state would have to decide whether to contribute more than the
11
The Administration's Medicaid proposal does not include a reduction in state matching requirements.
Neither did the Budget Resolution that Congress approved in June. The reconciliation bill Congress passed
did, however, reduce state matching requirements. It lowered the maximum state matching percentage to
40 percent, as the NGA proposal would. This change by itself would lower the average state share of
Medicaid costs from its current level of 43 percent to 38 percent. The reconciliation bill also changed some
factors used in calculating state matching percentages to reduce below 40 percent the matching percentage
for some states whose current matching rates exceed 40 percent, and to reduce to still lower levels the
matching rates for 12 states whose current rates already fall below 40 percent. Overall, the reconciliation
bill would lower the average state share of Medicaid costs from 43 percent to 37 percent.
12
The budget reconciliation bill that Congress passed also would have repealed the prohibitions against
these financing schemes. The Medicaid proposal in the Administration's budget would not repeal current
prohibitions on the use of such schemes.
16
amount needed to draw down its full federal payment. If it did so, a state would be
contributing state dollars for which it received no matching federal payments.
Since there would be no requirement for a state to contribute unmatched dollars,
many states likely would reduce their state contributions to the minimum level that
would secure their full federal payment. This would result in state funding reductions
relative to what states are projected to spend under current law, on top of the federal
funding reductions.
A second factor driving potential reductions in state Medicaid funding is the
proposed reduction in state matching percentages. Suppose a state whose current
matching rate is 50 percent receives federal Medicaid payments of $6 billion. Under
current law, the total size of the state's Medicaid program would be $12 billion - the
$6 billion provided by the federal government plus $6 billion provided by the state.
Suppose, however, the federal payment was capped at $6 billion and the state matching
share was reduced from 50 percent to 40 percent, as NGA proposes. State contributions
could drop to $4 billion. Total Medicaid funding could decrease from $12 billion to $10
billion.
Table 1
The Effect of Reducing the State Matching Rate
Existing law
NGA proposal
Federal share
$6 billion (50%)
$6 billion (60%) (amount capped)
State share
$6 billion (50%)
$4 billion (40%)
Total funding level
$12 billion
$10 billion
Now, combine the effects of these two factors. Suppose a particular state would
secure $7 billion in federal Medicaid funds under current law, matched by $7 billion in
state funds. Suppose also that NGA's new federal cap would reduce federal funding
for the state from $7 billion to $6 billion. And suppose the state's matching rate was
reduced from 50 percent to 40 percent, allowing the state to reduce its contribution to
$4 billion without losing any federal funds. The total resources available to the
Medicaid program in the state could shrink from $14 billion to $10 billion, producing
an overall reduction in funding for the state's Medicaid program of 29 percent.
17
Table 2
Capping and Cutting Federal Payments; Cutting the State Share
Existing law
NGA proposal
Federal share
$7 billion (50%)
$6 billion (60%) (amount capped)
State share
$7 billion (50%)
$4 billion (40%)
Total funding level
$14 billion
$10 billion
In short, the combined effect of the federal caps and the reductions in state
matching rates contained in the governors' proposal would be to facilitate very deep
reductions in state Medicaid funding. This, in turn, raises a related question. To
reduce state funding this much, states must be able to reduce substantially the cost of
their Medicaid programs. Could they do so?
Under the governors' proposal, the answer is "yes." The proposal allows states
to take an array of actions to shrink Medicaid coverage and reduce costs. States would
be able to scale back the health services their Medicaid program covers to whatever
degree they wish. They also could define "disability" narrowly and reduce the costs of
insuring the disabled population. Furthermore, states would be free to narrow
Medicaid coverage both for poor children over age 12 and for parents in welfare
families. States also would be able to reduce the fees paid to medical care providers to
the extent politically feasible.
In other words, states would have the ability to reduce Medicaid expenditures
Using the "Savings" to Expand Coverage
Some governors have suggested the proposed reduction in state matching
requirements is desirable because states could "use the savings to expand Medicaid coverage
for uninsured workers." This is not the case; reducing state matching requirements cannot
assist states in covering uninsured workers. To the contrary, it would make such coverage
expansions less likely and reductions in coverage more likely.
Reducing state matching requirements, as the governors propose, would enable states
to reduce their contributions for Medicaid without causing federal contributions to increase.
The result would be to lower the total amount of resources available to Medicaid.
A reduction in resources would necessitate reductions in the number of people
covered, reductions in the health services for which beneficiaries are insured, reductions in
the amount that providers are paid for their services, or some combination of such actions.
By definition, a reduction in total Medicaid resources does not provide new resources to
cover more people.
18
quite sharply, enabling a state to provide no state funding beyond the amount needed
to secure its full federal Medicaid contribution. In assessing whether states would
pursue such a course, it should be noted that state treasuries would get 100 percent of
the savings from such Medicaid cutbacks; the federal government would get none.
This differs dramatically from the situation under current law, where a state keeps
between 20 cents and 50 cents of each dollar saved from Medicaid cuts, depending on
the state.
How Much Might Total Medicaid Funding Be Reduced?
The governors' proposal does not specify the precise amount of federal Medicaid
savings it seeks to achieve. Several governors have suggested that total federal cuts
over seven years should fall between $59 billion - the amount in the President's 1997
budget - and $85 billion, the amount in the Republican Congressional leadership's
January budget offer.
On this basis, it is possible to calculate the amount of federal, state, and total
reductions in Medicaid funding that could occur under the NGA proposal. If each state
contributed the amount needed to draw down its full federal payment but no more
than that, the results would be as follows:
If the seven-year federal funding reduction were $59 billion and state
matching requirements were reduced only for states with current
matching rates above 40 percent, states could cut their Medicaid
contributions $182 billion over seven years. Under this scenario, the total
reduction in federal and state funding combined would be $241 billion
over seven years. The reduction would grow in depth with each year,
reaching 19 percent in 2002.
If the seven-year federal cut were $85 billion and state matching
requirements were reduced in the same manner as under the
Congressional reconciliation bill (see footnote 11), states could reduce
state funding by $214 billion over seven years. In this case, the total
seven-year cut - including both federal and state reductions - would
equal $299 billion, reaching 26 percent by 2002. (See Table 3.)
In both cases, states would be able to reduce state funding more than
twice as much as federal funding would be cut. Between 72 percent and
76 percent of the potential Medicaid funding reductions would consist of
reductions in state contributions.
It is instructive to contrast the potential funding reductions under the governors'
proposal with the funding cuts envisioned last spring in the Congressional budget
resolution. The budget resolution called for $182 billion in federal Medicaid cuts and
explicitly rejected any changes in the federal/state matching percentages. The federal
19
Table 3
Potential Reductions in Medicaid Funding
(In billions)
Minimum
Maximum
7-year
In 2002
7-year In 2002
Federal reductions (net)¹³
$59
11%
$85
18%
State reductions:*
-- because of federal cap
$ 48
$ 69
-- because of FMAP change
$134
$145
Total state reductions
$182
30%
$214
37%
Grand total reductions*
$241
19%
$299
26%
* Assuming states contribute only the amount needed to draw down the maximum federal
payment to which they are entitled.
13 The exact level of a new "special" grant for undocumented aliens, which is part of the governors'
proposal, makes a small difference in the size of the potential state and total funding reductions
because the aliens grant would be exempt from state matching requirements. If the net federal cut is
$59 billion and the new aliens grant is $3.5 billion, the gross federal cut is $62.5 billion. It is the gross
cut that determines the size of the potential reductions in state matching payments.
The NGA did not specify the size of the aliens grant. An aliens grant of $3.5 billion is assumed
here as part of the $59 billion net federal reduction. An aliens grant of $6 billion is assumed as part of
the $85 billion net federal cut. The $3.5 billion figure reflects the size of the aliens grant in the
reconciliation bill. The $6 billion figure is the size of the aliens grant in the "Medigrant II" proposal,
which House Commerce Committee staff circulated on the eve of the NGA meeting as part of a
proposal to achieve $85 billion in federal Medicaid savings and which formed part of the basis of the
NGA plan.
reductions of $182 billion proposed at that time would have produced a potential total
funding reduction of $320 billion over seven years, taking state reductions into account.
This means that, while proposed federal funding reductions would be less than half as
deep as they were last spring, the total Medicaid funding reductions that would result
from the governors' plan is nearly as large as the total cut that could have occurred
under the original Congressional plan. (See Table 4; also see Appendix B for a
Table 4
Potential Reductions in Medicaid Funding - Then and Now
(1996 2002, in billions)
Potential
Potential
Federal
State
Total
Reductions
Reductions
Reductions
Congressional budget plan (June 1995)
$182
$138
$320
Governors' plan, maximum (Feb. 1996)
$85
$214
$299
20
description of the data and methodology that underlies the calculations and
Appendix C for a listing of current and proposed state matching rates.)
Governors' Plan Likely to Lead to Substantial Cost-Shifting
The Medicaid funding reductions that would occur as a result of the NGA plan would likely lead
to substantial cost-shifting. Since the governors' plan could result in as much as $299 billion in federal
and state funding reductions over seven years, the degree of cost-shifting could be quite large.
Funding reductions of this magnitude greatly exceed what most experts believe can be achieved
through efficiencies and service delivery reforms, such as the greater use of managed care. Such
reductions in funding would lead to some combination of: greater numbers of people going without
needed care; greater reliance on emergency rooms at city and county hospitals and on other locally
operated public health facilities; increases in private-sector health insurance premiums as medical
providers who are undercompensated by Medicaid spread their costs; and reduced income for medical
providers. The second and third of these scenarios entail cost-shifting to local taxpayers and to those
who pay for private-sector health insurance policies, principally employers and employees.
Cost-shifting would occur both because providers would be paid less for the services they
perform and because some individuals would lose coverage entirely or for some needed health care
services. Some people would go without needed care or pay for care from their own limited resources.
Others, however, would use emergency rooms or other "free" providers. As a result, the number of
people receiving uncompensated care would increase. (Moreover, in many cases, care likely would be
delayed until medical problems became more serious, causing the cost of uncompensated care that
ultimately was provided to rise further.)
In the past, when provider payments were squeezed or uncompensated care increased, doctors
and hospitals routinely increased the fees they charged to those with private-sector (e.g., employer-
based) health insurance. This increase was one reason that health care premiums rose so rapidly in
recent decades - individuals with private-sector health insurance paid "too much" to cover shortfalls
in Medicare, Medicaid, and uncompensated care. Cost-shifting was one of the factors that prompted
some businesses to drop health insurance coverage as premium costs climbed.
In the current environment, providers have less ability to increase charges to the private sector
because a growing portion of physician and hospital care is financed through managed care
companies. The market power of managed care enterprises makes them able to resist attempts by
individual hospitals and doctors to raise prices. Consequently, only a portion of the Medicaid funding
reductions that would occur under the governors' plan would likely be cost-shifted to businesses and
insured workers.¹⁴
The increasing difficulty of shifting costs to private-sector insurance plans has two implications.
First, if uncompensated care becomes scarcer, a greater number of sick, poor, uninsured people will
have difficulty receiving medical assistance. Second, city and county hospitals and other providers of
uncompensated care are likely to face a noticeably increased caseload. The cost of that increased
caseload will be borne largely by local taxpayers in the form of either tax increases or reductions in
other services.
14 Cost-shifting to private insurance plans is a hidden tax on businesses, working people, and others with
private-sector health insurance. Employees bear the brunt of this cost shift; most economists believe that
employer-paid costs for benefits such as health insurance are largely passed on to workers in the form of
lower wages than they would otherwise be paid.
21
Bogus Financing Schemes
In one sense, the figures presented here concerning potential state funding
reductions are a worst-case scenario; they show the loss of Medicaid funding that
would result if no state contributed unmatched dollars to Medicaid. In another sense,
however, these figures understate the extent to which state funding could be
withdrawn. Reductions in state Medicaid resources could be even deeper if states
begin using sham financing schemes to meet a portion of their Medicaid matching
requirements. As noted, the governors' proposal would drop all legal bars to the use of
such financing schemes.
In the past, a number of states used creative financing schemes to make
payments which they could call "Medicaid contributions" but that really were not. For
example, a state might impose a special "tax" on a health care provider and then rebate
to that provider the amount collected from it. The provider and the state would each
be in the same financial position as if this back-and-forth transfer had not occurred.
But the state could call the rebate a "Medicaid expenditure" and claim federal matching
funds for it.
Similarly, a state might make a special "intergovernmental transfer" from one
state entity - for example, a state hospital - to the state Medicaid program and then
promptly rebate to the hospital the amount collected from it. The state and the hospital
would each be in the same position as if this transfer had not occurred. But here also
the state could call the rebate a "Medicaid expenditure" and claim federal matching
funds for it. Provider tax rebates and intergovernmental transfers are two versions of
the same shell game. Congress largely banned such sham transactions in the early
1990s. The NGA proposal, however, would make them legal again. (See the box on the
next page for a more extensive treatment of this issue.)
Until being outlawed in the early 1990s, sham financing was used by some states
to extract extra federal Medicaid payments without providing the requisite amount of
additional state matching funds. This increased federal costs. Under the governors'
proposal, federal payments would be capped, and sham financing consequently would
not generate more federal money. Rather, sham financing would allow a state to
withdraw even more of its own funding without losing federal dollars. In effect,
legalizing sham financing makes state matching requirements meaningless. The result
would be a larger reduction in the total resources available to Medicaid for finance
health care services, and hence larger cutbacks in the categories of people insured, the
types of health services covered, or the payment rates for providers.
"Heads I Win, Tails You Lose"
As described above, under the governors' proposal, the level of federal Medicaid
payments to states would be capped. For any state, the cap would equal the state's
22
Examples of How Special Medicaid Financing Methods Can Allow
States to Draw Down Federal Dollars Without Spending State Funds
The following example illustrates how some sham financing schemes worked in the past.
Assume a state imposes a provider tax that is paid by hospitals and that raises $40 million
dollars. The state then pays back to the hospitals that are subject to the tax $50 million in
disproportionate share hospital ("DSH") payments. (These payments are supposed to
provide additional funds to hospitals that serve a disproportionately high number of
Medicaid and low-income uninsured patients.) If the state's federal Medicaid match rate is 50
percent, it can claim $25 million in federal Medicaid funds based on the $50 million in DSH
payments it has made to the hospitals.
The result is that the hospitals gain $10 million ($50 million in DSH payments less the $40
million in provider taxes), while the state gains $15 million (it receives $25 million in federal
matching funds plus $40 million in provider taxes while disbursing $50 million in DSH
payments). Thus, the federal government pays $25 million without any net state funds
having actually been expended.
Michigan's practices are instructive. Michigan is not the only or most egregious example
of a state that has used such financing methods. It is cited here because the following
example has been documented by GAO and provides a good illustration of how this practice
works.
In fiscal year 1993, Michigan raised $452 million through hospital donations and then paid
the hospitals $458 million in disproportionate share (DSH) payments. Based on these
payments, Michigan claimed $256 million in federal matching funds. The net effect of these
transactions was as follows: the hospitals gained $6 million ($458 million in DSH funds less
$452 million in provider donations); the state gained $250 million ($256 million in federal
matching funds less $6 million in net payments to the hospitals); and the federal government
paid $256 million in federal matching funds without state funds having been expended.
When provider donations were limited by Congress through legislation enacted in 1991
that became effective in January 1993, this loophole was closed. Michigan responded by
relying on intergovernmental transfers and changing its criteria for deciding which hospitals
would qualify for DSH payments. In October 1993, Michigan paid $489 million to the one
hospital that met its new DSH definition, the state-owned University of Michigan hospital.
The state claimed $276 million in federal matching funds for this payment, but the public
hospital returned the full $489 million payment to the state through an intergovernmental
transfer the day the payment was made. Through this one transaction, Michigan realized a
net gain of $276 million in federal Medicaid payments, again without expending any state
funds. This practice is now limited through additional tightening provisions that were
enacted in 1993 and took effect in 1994.
Source: GAO, States Use Illusory Approaches to Shift Program Costs to Federal Government, August 1994.
basic grant (i.e., the level of federal Medicaid expenditures in the state during the base
year, increased to reflect a growth factor built into the statute), plus the federal
23
umbrella payments the state would receive if the actual number of Medicaid
beneficiaries in the state exceeded the number reflected in the state's growth factor
when the legislation was enacted.¹⁵
If the actual number of Medicaid enrollees in a state exceeded the number
reflected in the growth factor, the cap on federal Medicaid payments to that state
would increase accordingly. But if the actual number of enrollees in the state fell below
the level assumed in the state's growth factor, the federal cap on payments to the state
would not decrease. States consequently would be in an enviable position — they
would receive more federal funds if beneficiary growth exceeded expectations, but
would not receive less funding if beneficiary growth fell short of expectations. The
plan thus provides states with an incentive to restrict coverage, since they would lose
no federal funds by doing so and all of the savings would accrue to state treasuries.
Moreover, the federal government would have to be able to predict beneficiary
growth with perfect accuracy on a state-by-state basis to avoid incurring unintended
federal costs. If the federal government's prediction of national beneficiary growth
were perfect, but some state caseloads grew faster than expected while others grew
more slowly, the federal government would end up spending more than forecast. In
addition, federal payments to states with slower-than-anticipated caseload growth
would be more generous than anticipated, raising issues of equity among states. (See
box on next page.)
DSH and Bogus Financing Schemes
In recent Congressional hearings, one governor said that repealing the current
prohibitions on sham financing should not be a concern. Disproportionate Share Hospital
(DSH) payments probably would not exist under the governors' Medicaid proposal, he
indicated, and as a result the opportunity for state financing games would disappear.
This conclusion is not correct. In the past, states characterized their rebates of
provider taxes or intergovernmental transfers as "Disproportionate Share Hospital
payments" to draw down federal matching funds. Under the governors' proposal, this would
be not necessary. In fact, there would be a wider, not a narrower, field for such financing
scams.
For example, states could impose special "taxes" on HMOs or other large managed
care providers covering Medicaid enrollees. States then could rebate those "taxes" to HMOs
and characterize the rebates as state Medicaid payments. It would not be necessary to label
these rebates as DSH payments to employ these schemes; under the governors' plan, states
could make such rebates by using the discretion the plan would give them to establish special
rates for certain groups of providers. (Note: rebating "taxes" or "contributions" is easier
when the state can deal with a few big entities, such as a few large urban hospitals. Large
HMOs could be the vehicles for such financing maneuvers in the future.)
15
An alternative way of interpreting how the caps would work is provided in Appendix A.
24
This raises a related issue. If budget estimators at the Office of Management and
Budget and the Congressional Budget Office take into account the extent to which state-
by-state caseloads may differ from expectations, their estimate of the savings from this
one-sided approach to setting federal caps is likely to be small.
This will present Congress with a choice. Congress could settle for lower
savings in the Medicaid area. The result would be weakened health care coverage for
millions of low-income Americans and very small federal savings. Alternatively,
Congress could reduce the basic grants and federal spending caps for all states to make
up for the lost savings. Such an approach, however, would penalize states whose
caseload levels equaled or exceeded the anticipated level - and would likely require
sharper cutbacks in Medicaid services in such states - while still according favorable
How the Governors' Proposal Would Treat States Inequitably
A hypothetical example helps to illustrate how the NGA funding structure would
likely result in some states' receiving windfalls while harming other states or the federal
treasury. Imagine two states that each receive $5 billion in federal Medicaid payments in the
base year, and in each of which caseload growth is forecast to be two percent per year.
Suppose also that the portion of the growth factor that is intended to help cover increases in
the cost of providing medical services to beneficiaries (as distinguished from cost increases due
to increases in the number of beneficiaries) has been set at about three percent. Under the
governors' proposal, the two states would both receive an overall federal funding increase of
five percent over the base-year level - three percent for increases in the cost of delivering
medical care and two percent for caseload growth. The basic grants these two states would
receive consequently would each equal $5.25 billion ($5 billion plus five percent).
Suppose, however, that the Medicaid caseload actually grew only one percent in one
of these states while growing three percent in the other state, instead of growing two percent
in both states. Total caseload growth in the two states combined would equal expectations.
But the state experiencing one percent caseload growth would get a $50 million windfall; it
would get federal funds for one percent more beneficiaries than it actually served. The
second state would not receive a windfall but would not be hurt, as it would receive an extra
$50 million from the federal umbrella fund to cover its higher-than-anticipated caseload
growth.
The Congressional Budget Office might anticipate this problem and lower its savings
estimate as a result. If that occurs, Congress may decide to offset the loss in savings by
reducing, for all states, the growth factor allowed for increases in the cost of delivering
medical services. In this example, that growth factor might be reduced from three percent to
2.5 percent; that reduction would offset the $50 million federal loss that would otherwise
occur as a result of the first state's receiving the $50 million windfall described above. But
such an attempt to avoid federal losses would not prevent the inequitable treatment of some
states and would create other difficulties. If the cost of delivering medical care services grew
more rapidly than 2.5 percent, the state whose caseload growth exceeded expectations would
be shortchanged; it would receive insufficient federal funds to deal with increases both in the
cost of medical services and in the number of beneficiaries.
25
treatment to states whose caseloads turned out to be smaller than predicted.
These problems are not difficult to correct. The remedy is to allow the federal
caps to adjust upward or downward if a state's caseload turns out to be higher or lower
than anticipated.
Gaming the System
A number of states may contribute just enough state funds to Medicaid to draw
down the maximum federal payments to which they are entitled. But some states may,
as a matter of policy or for other reasons, find themselves contributing more than the
minimum. These states, which would be contributing unmatched dollars and might
not be overly pleased by that development, would face an enticing prospect - they
would be able to "game the system" and secure substantial amounts of additional
federal revenue.
Suppose a state finds that caseload growth exceeds the level anticipated in the
state's growth factor. In such a case, the federal government would pay additional
amounts to the state on behalf of each additional beneficiary beyond the number
originally forecast (except for additional children covered at state option). Since the
state is providing more state funding than needed to meet its matching requirement,
the state will be able to receive the federal umbrella payments without contributing any
additional state matching funds.
In this circumstance, the state will be in a position comparable to that of a health
maintenance organization (HMO) - it will receive an additional federal payment for
each new person it enrolls while incurring costs only to the extent required to pay the
actual medical bills of the new enrollees. In effect, the federal payment will be a
"capitation" payment.¹⁶ When coupled with other provisions of the governors' plan,
this approach provides a strong - perhaps irresistible - temptation for states to
engage in "gaming."
States could, under the NGA plan, provide different benefit packages for
different groups of beneficiaries, with some benefit packages being adequate and
others greatly scaled back. A state that is contributing more state dollars than needed
16 The per-capita federal umbrella payments would apparently be based on the average cost of
beneficiaries in each of several broad beneficiary categories such as the elderly, the disabled, and children.
(The governors' proposal refers to "additional funds for certain populations," which is generally
understood to mean that the formula for determining the size of the per-capita umbrella payments will
vary for different groups of Medicaid enrollees, such as the elderly, children, the disabled, etc.) The
governors did not specify how many such beneficiary groups should be created or how the level of the per-
capita payments should be set. One approach would be to have the per-capita payments for each group
equal average federal Medicaid costs for that group in the base year, adjusted by the same general growth
factor used in the basic grant for the state (excluding that portion of the growth factor intended to cover
anticipated caseload increases).
26
to meet its matching requirement could seek as many additional enrollees as possible in
certain beneficiary categories to maximize its federal umbrella payments, while
providing the additional enrollees only minimal health benefits at low state cost. The
state also could concentrate on enrolling categories of new beneficiaries likely to be
healthy in order to keep the costs of covering the beneficiaries low. The state could
even drop coverage for new enrollees who had the misfortune to get sick too often, just
as insurance companies sometimes drop coverage for those with too many claims. As
long as the federal umbrella payment the state received for each additional beneficiary
was higher than the average cost of medical care for these new enrollees, which would
be easy to arrange, the state treasury would make money on each additional enrollee.
As a result, the federal caps, intended to generate federal Medicaid savings for
the federal government, could become rather meaningless. Federal Medicaid
expenditures would rise toward the level they would have attained had federal
Medicaid law not been changed. Federal savings would dissipate even though the
additional Medicaid beneficiaries might not get meaningful health care coverage.
As noted, states will be able to "game the system" in this manner only if they are
contributing, or appearing to contribute, some unmatched state dollars. Even if bogus
financing schemes are not permitted, the design of the governors' funding proposal
thus leaves federal policymakers with a dilemma. If all states reduce their state
contributions to the maximum extent allowed, the risk to the federal treasury posed by
this type of gaming will not materialize. But there will be $182 billion to $214 billion in
state funding cuts, and Medicaid beneficiaries are likely to suffer considerably.
Alternatively, if states do not reduce their funding levels nearly as much as $182 billion,
many states will find themselves in a position to exploit federal umbrella payments to
the detriment of the federal treasury.¹⁷
In theory, any Medicaid reform proposal that includes capped per-beneficiary
federal payments can present states with the possibility of gaming the system. Other
proposals that would provide capped federal payments to states on a per-beneficiary
basis, however - such as the Clinton Administration's proposal, the Medicaid
legislation designed by the conservative Democratic "Coalition" in the House of
Representatives, and the proposal Senate Democrats offered last fall - include features
that minimize these risks to the federal government. These features include
17 The governors' proposal states: "Appropriate provisions will be established to ensure that states do
not have access to the umbrella fund unless there is a demonstrable need." This vague statement appears
not to have much meaning, however, given the other features of the governors' plan. For example, suppose
it means that states will receive per-capita payments only on behalf of additional enrollees who are sick
and receiving meaningful health benefits from the state. This concept would be unenforceable since it is
difficult to distinguish "additional" enrollees from "anticipated" enrollees. How can the state tell, for any
individual enrollee, whether he or she was one of the anticipated ones or an additional one? Furthermore,
if a standard of "demonstrable need" is to be effective in preventing states from gaming the system,
enforcement by the Health Care Financing Administration and meaningful federal benefit standards will
both be essential. Such measures would, however, run afoul of other aspects of the governors' proposal.
27
maintaining existing prohibitions of bogus financing schemes, requiring an adequate
and fundamentally equal benefit package for every beneficiary in the state, and
preserving existing state matching requirements.¹⁸
Inadequate Adjustments for Inflation
If the general inflation rate in the U.S. economy is higher than expected, medical
care will cost more due to no fault of the federal government, the state, or state
Medicaid programs. Consequently, any Medicaid proposal should provide states and
beneficiaries with protection against higher-than-anticipated inflation, as the current
Medicaid program does.
At first blush, the governors' proposal appears to provide such protection. The
"basic grant" paid to states is supposed to include "an inflation factor." In fact,
however, this turns out to mean only that an inflation factor based on current inflation
forecasts is built into the basic grant and umbrella payment structure. No adjustment
would be made if the actual inflation rate turns out in coming years to be higher or
lower than today's forecasts predict.
This is a serious deficiency in the plan. While the governors' proposal provides
for an adjustment in federal funding levels if Medicaid caseloads rise beyond
expectations (except for optionally covered children), it provides no comparable
adjustment if the general inflation rate exceeds expectations. The Medicaid caps
included in both the Administration and Coalition Medicaid proposals do contain such
an adjustment.
An example helps to show why federal Medicaid payments should be adjusted
if inflation is higher or lower than forecast. Suppose the general inflation rate is
expected to be three percent per year. Suppose also that Medicaid costs (exclusive of
costs due to caseload growth) are projected to grow six percent per year under current
law (three percentage points above the general inflation rate), and policymakers are
contemplating capping Medicaid cost growth at four percent per year (allowing only a
one percent margin above the general inflation rate to reflect more rapid increases in
18
Other legislation with per-beneficiary federal caps minimizes the risks of state gaming in several
ways. First, states would not be allowed to use bogus financing schemes to meet their matching
requirements. Second, states would be far less likely to be contributing unmatched state dollars, since their
matching rates would not be reduced. States not contributing unmatched dollars cannot game the system
in this fashion, because they would have to contribute additional state matching funds to go along with the
federal umbrella payments being received on behalf of additional beneficiaries. Finally, even if states were
contributing unmatched state dollars, they would find it difficult to limit enrollment to new beneficiaries
whose medical care cost less than the federal per-capita payment. Medical underwriting (that is, selecting
only healthier people to enroll), disenrollment of people who become too sick, and skeletal benefit
packages all would be prohibited under these other Medicaid proposals. States would have to provide
adequate benefits to all enrollees due to federal benefit standards, the continuing federal requirement that
benefits be of reasonable amount, duration, and scope, and federal rules requiring comparable benefits and
access throughout a state.
28
health care costs due to the ongoing development of improved medical technologies).
Rather than establishing a rigid formula that inflexibly fixes the allowable growth rate
at four percent per year, policymakers could set the growth factor at "one percent
above actual inflation." If actual inflation turned out to be 3.5 percent instead of 3
percent, the cap would allow 4.5 percent growth in medical costs. Conversely, if
general inflation was only 2.5 percent, the cap would allow 3.5 percent medical cost
growth.
In both instances, costs would continue to be squeezed by the amount
considered appropriate when the legislation was drafted (in this example, by two
percentage points, since Medicaid costs were assumed to rise three percentage points
more than the general inflation rate in the absence of legislation to overhaul the
program). If, instead, the allowable growth rate were inflexibly fixed at four percent -
rather than at one percent above the actual inflation rate - costs would be squeezed
either too much or not enough, depending on whether the general inflation rate was
higher or lower than had been forecast. Adjusting the cap so it increases or decreases if
inflation is higher or lower than CBO has forecast thus would produce a more rational
result.
This approach also would afford more protection to states. If, over the next
seven years, inflation averages one percent per year higher than CBO currently expects,
the additional Medicaid costs would total $73 billion under current law, with states
bearing $31 billion of these costs. Because the governors' plan lacks an adjustment in
the caps to reflect inflation that is higher or lower than expected, however, states either
would have to bear themselves all of the additional Medicaid costs that would result
from higher-than-forecast inflation or else would have to restrict Medicaid eligibility,
scale back the health services covered, or reduce payments to providers to achieve cost
reductions to offset the effects of higher inflation.
The approach recommended here would not reduce federal Medicaid savings. If
inflation proves to be higher than is currently forecast, federal Medicaid costs under
current law would be higher than CBO currently projects. If the governors' Medicaid
proposal were modified so it changed in cost when the general inflation rate varied
from expectations, the amount saved - relative to what Medicaid would have cost the
federal government without reform legislation - would remain virtually the same.
The amount of federal savings that the Medicaid spending caps generated, and the
amount by which the federal deficit would be reduced, would be essentially the same
as the amounts that CBO estimated at the time of the legislation's enactment.
Such an approach also would not increase the federal deficit. The Congressional
Budget Office, the Office of Management and Budget, and other analysts have long
found that inflation has little or no effect on the deficit. If inflation is higher than
expected, federal outlays increase, but federal revenues rise by about the same
29
amount. 19 Therefore, the approach recommended in this paper would also protect the
federal government against the possibility that inflation might be lower than currently
forecast.
The possibility that the general inflation rate may surpass current forecasts
should not be ignored. CBO currently projects that general inflation will average 2.8
percent per year for the foreseeable future. In the 1980s, general inflation averaged 5.2
percent per year, while the average inflation rate was 7.0 percent in the 1970s. 20 (It was
2.7 percent in the 1960s.) Though the underlying inflation rate in the economy is lower
today than in the previous two decades, CBO's record on economic forecasting - while
as good or better than anyone else's - is far from perfect. In early 1988, for example,
CBO overestimated inflation for the year already in progress by a full percentage point.
In 1990, CBO underestimated inflation for the year in progress by half a percentage
point.
CBO's projections are necessarily more speculative over a longer period of time.
For example, CBO's baseline economic assumptions published in January 1995 assume
prices in 2002 that are 4.3 percent higher than CBO assumed two years earlier, in its
January 1993 assumptions. The assumptions CBO made back in January 1985 of what
prices would be in 1992 turned out to err in the other direction; actual prices were 4.5
percent lower than CBO had predicted. High-quality seven-year price forecasts can be
off as much as 5 percent in either direction during an era of relative economic stability.
For Medicaid, this means that total program costs in 2002 could be $15 billion
higher or lower than CBO now expects solely because of uncertainty about inflation.
This underscores why adjusting Medicaid caps up or down to reflect the extent to
which inflation is higher or lower than anticipated should be a basic part of any
Medicaid proposal that includes a cap.
(Note. The analysis in this chapter assumes a straightforward interpretation of the
financing aspects of the NGA proposal. Alternative interpretations produce different
problems; see Appendix A.)
19 See The Economic and Budget Outlook: Fiscal Years 1996-2000, Congressional Budget Office, January
1995, pages 78-79. If inflation is higher than expected, state revenues increase as well. Under current law,
higher inflation leads to higher state Medicaid costs and to higher state revenues in the same proportion.
Under the governors' proposal, by contrast, higher-than-anticipated inflation would force the state to
absorb what under current law is both the state and the federal share of the increase in Medicaid costs caused
by higher inflation. In such a case, state Medicaid costs would grow much more rapidly than state
revenues would.
20
These figures reflect the average annual percentage change in the GDP implicit price deflator on a
calendar-year basis.
30
IV.
Summary and Recommendations
The NGA plan could result in the loss of much of the intended federal savings
while placing substantial numbers of low-income children, parents, and elderly and
disabled individuals at risk of losing some or all of their health insurance coverage.
Although the plan advances a number of important principles, including the basic
concept that federal funding should follow enrollees and increase when enrollment
rises, it is seriously flawed. In particular, its financing provisions - combined with the
sweeping discretion granted to states over coverage and benefits and the lack of
federally enforceable legal protections - are likely to lead to an increase in the ranks of
the uninsured and to excessively scaled back benefits for many who retain coverage.
Despite their severity, these problems can be remedied within the basic
Medicaid structure the governors have proposed. This chapter briefly describes how
policymakers can address the major shortcomings of the governors' proposal in the
areas of coverage, benefits, financing, and legal protections. The remedies described
here would increase federal savings and avoid changes that would greatly weaken the
health care safety net, while affording states flexibility to alter their Medicaid programs
in a number of important areas.
Coverage
The governors' plan would cause three principal groups to lose the guarantee of
health care coverage provided under current law. These coverage gaps can be closed.
The three groups are as follows:
Poor children over age 12. The governors' plan makes coverage of this
group of children optional for states; up to three million children could be
31
affected. The guarantee of coverage for poor children over age 12 that is part of
current law - and is phasing in through 2002 - can be retained.
Large numbers of children and parents who now qualify for Medicaid
based on their receipt of AFDC. The plan would allow states to deny
coverage to substantial numbers of poor children over 12 and poor
parents who now receive Medicaid based on their receipt of AFDC.
Health care coverage for up to four million parents and 1.5 million
children over 12 is at risk.
To prevent erosion in coverage, states can be required to cover children and
parents whose income is below current AFDC standards. Such a requirement can
be designed in a way to make it simple for states to administer.
People with disabilities. The governors' plan would give states total
discretion to define who would qualify based on disability. Being
sufficiently disabled and poor to receive SSI would no longer provide an
assurance of Medicaid coverage. (As noted in Chapter II, the plan's "set-
aside" requirement for the disabled is of limited help. Under the set-
aside, Medicaid funding for coverage of the disabled could, by 2002, be
as much as 40 percent below the Medicaid funding levels projected for
coverage of the disabled under current law.)
The governors' plan would require states to continue covering elderly
people who meet SSI income and asset standards. States also can be
required to cover disabled people who meet SSI disability and financial eligibility
standards.
Benefits
No federal benefit standards. One of the most significant problems with
the plan is that it grants states unlimited discretion to define the amount,
duration, and scope of the services that will be offered. This means that the
coverage guarantees the governors propose for poor pregnant women,
poor children under 12, and elderly SSI recipients would mean little, since
Medicaid coverage for some of these groups could consist of insurance
only for a rather skeletal benefits package that fails to include key health
care services. The lack of benefit standards also allows for "gaming" by
states. Federal rules requiring states to provide services that are sufficient in
amount, duration, and scope can be retained and applied to all groups of
beneficiaries.
32
Changes in "EPSDT." Under the plan, children would no longer be
assured of receiving the treatment they need if a medical problem is
discovered during a periodic health examination or screening. This
change is particularly troublesome in light of the elimination of basic
federal benefit standards. As a result of these two changes, many poor
children could fail to receive basic treatments a doctor prescribes. This
problem can be addressed by maintaining EPSDT rules.
Changes in benefit coverage for "QMBs." Some poor elderly and
disabled people who receive Medicare (called "Qualified Medicare
Beneficiaries," or "QMBs") may face significant increases in out-of-pocket
costs because Medicaid would, in many cases, leave a portion of their
Medicare co-payments uncovered. Medicaid can cover the full cost of
Medicare cost-sharing obligations for these poor beneficiaries, as it does under
current law.
Financing
The plan would permit states to withdraw large amounts of state funds from
Medicaid; it would allow states to withdraw approximately $200 billion over the next
seven years without that affecting the level of federal Medicaid funding they receive.
State Medicaid cuts could be nearly three times as deep as the federal reductions. The
potential to reduce state funding to this degree is likely to prompt states to take
advantage of opportunities allowed under the plan to restrict coverage and to scale
back benefits for those who remain insured.
State Matching Requirements
The NGA plan allows at least 25 states to cut state funding by up to one-
third without losing any federal funds; it does this by reducing state
"matching requirements." Current state matching rates can be retained.
Financing Gimmicks
The plan allows states to reduce state funding to a still-greater degree by
using financing gimmicks that are currently illegal, including the use of
selective provider taxes and intergovernmental transfers. Current
prohibitions and limitations on such financing gimmicks can be retained.
The Basic Payment and the "Umbrella Fund"
The NGA plan includes both basic block grant payments to states and
"umbrella" payments to cover additional beneficiaries who enroll. The umbrella fund
33
is a fundamental part of the NGA plan; it ensures that funding follows people and
protects states from the effects of recessions and other unexpected changes in caseload
size or caseload mix. But the system of block grant and umbrella funds designed by
NGA has four significant flaws that need correction.
No adjustment for inflation. The plan establishes "basic" block grant
payments to states, with the calculation of these payments based partly on
CBO's current inflation assumptions. The plan fails to adjust these
payments if the overall inflation rate in the U.S. economy turns out to be
higher or lower than CBO has forecast. States and beneficiaries will be at
risk if the general inflation rate is higher than forecast. The federal
government will pay too much if inflation is lower than forecast. This can
be remedied by setting the level of growth that Congress wishes to allow in block
grant payments at a specified amount above or below the general inflation rate.
For example, if the general inflation rate is forecast to be three percent,
and on that basis, Congress wishes to allow four percent growth,
Congress should set the growth factor at one percentage point above the
general inflation rate. (Note: the GDP price deflator can be used here as
the inflation measure; the Consumer Price Index need not be involved.)
The Medicaid proposals advanced by the Coalition and Senate Democrats
have followed this approach to dealing with inflation.
The federal deficit is not affected by this change. CBO has found that
when inflation is higher or lower than forecast, this does not affect the
deficit since it results in changes in revenues and outlays that cancel each
other out.
No adjustment if caseload falls. States in which caseloads exceed
expectations will get additional federal funds. But if a state's caseload
falls below expectations, the state gets to pocket federal money that,
under the governors' plan, it does not need. This reduces federal savings
and means that states whose caseloads fall below anticipated levels will
receive windfalls. It also means that states which reduce caseloads by
restricting coverage can do so - and lower their costs - without losing
any federal funds. Federal payments should decrease if caseload comes in below
expectations, just as the payments would increase if caseload exceeds expectations.
States can game the system. In some circumstances, states could "game"
the umbrella fund, because protections against gaming included in other
plans that allow for per-capita payments are missing from the governors'
plan. States could increase their caseloads by enrolling new beneficiaries
while keeping costs very low by giving the new enrollees a minimal
benefit package. The states would claim "per-capita" payments from the
34
federal government for the new enrollees; since states could arrange
matters so that the cost of serving these additional beneficiaries was less
than the per-capita federal payments they would receive, states could
make a profit from these transactions and deposit the extra funds in their
state treasuries.
This problem can be addressed by maintaining federal benefit standards and
providing full umbrella payments only to states that provide the full range of
basic benefits to enrollees.
No umbrella payments for optional children and pregnant women. The
umbrella fund fails to cover increases in the number of those children and
pregnant women who are not "mandatory" beneficiaries. This means, for
example, that if a state elects to cover working poor children over age 12
and the number of such children increases during a recession, the state
will receive no additional federal Medicaid payments to cover the
additional caseload. This may strongly discourage states from covering
such children.
The umbrella funding mechanism can be modified so it covers all mandatory and
optional categories of beneficiaries. Under the governors' plan, the umbrella
fund already applies to caseload increases for all categories of elderly and
disabled beneficiaries. It also should apply to all categories of children
and pregnant women, rather than just to mandatory categories of these
groups.
Loss of Legal Protections
Repeal of Title XIX. The plan would repeal the statute that governs
Medicaid. Key protections included in the statute - such as the ban
against providers billing Medicaid patients, limits on cost-sharing
requirements, and quality standards - are at risk. Title XIX can be
retained as the basic law and amended to reflect the changes that policymakers
wish to make to produce savings and accord states flexibility.
No access to federal court. Neither beneficiaries nor providers would be
allowed to bring suit in federal court, even if their state was violating
federal law and misusing federal funds. No other federal law guarantees
a benefit to eligible individuals and provides billions of federal dollars to
states to honor that guarantee, while denying eligible individuals access
to federal court if a state violates these federal guarantees. This problem
can be addressed by continuing to allow federal Medicaid claims to be brought in
federal court.
35
Summary of Recommendations
Retain the guarantee of coverage for poor children age 13-18, which is now
being phased in.
Require states to cover children and parents whose income is below current
state AFDC standards as well as individuals who meet SSI disability and
financial eligibility standards.
Retain federal rules requiring states to provide services that are sufficient in
amount, duration, and scope; tie a state's receipt of full umbrella payments to
its provision of the full range of basic benefits.
Maintain current EPSDT rules.
Do not reduce state matching rates.
Retain current prohibitions and limitations on financing gimmicks such as
provider taxes and intergovernmental transfers.
The basic grant should grow by some designated percentage above or below
the actual inflation rate.
Payments to states should decrease if caseload falls, as well as increasing if
caseload rises.
"Umbrella" payments should cover caseload increases for all beneficiary
groups, including both mandatory and optional groups.
Retain Title XIX as the basic law and amend it as desired to reflect agreed-
upon changes.
Continue to allow federal Medicaid claims to be brought in federal court.
Continue to cover the full cost of co-payments for Qualified Medicare
Beneficiaries.
36
APPENDIX A: ALTERNATIVE INTERPRETATIONS PRODUCE
DIFFERENT PROBLEMS
The analysis in this paper assumes the most straightforward interpretation of
federal Medicaid payments under the NGA proposal. We assume that the "basic
grant" is intended: a) to fully cover projected caseload growth, including changes in the
mix between high-cost and low-cost beneficiary groups; and b) to partially cover
increases in the cost of delivering medical care. States would be guaranteed their basic
grant. In addition, they would receive "umbrella" payments to fully cover the federal
share of additional costs if caseload (or caseload mix) exceeded the initial projections.
Other formulations of the basic grant and umbrella payments also are possible.
One such formulation may be significant because of its similarity to the Medigrant II
proposal advanced by the staff of the House Commerce Committee in January. Under
the alternative formulation:
Each year, the Department of Health and Human Services (HHS) would
alter the distribution of basic grant funds among states. At the beginning
of each fiscal year, the distribution used in the prior year would be
revised to reflect the most recent state-by-state data on the distribution
and case mix of Medicaid enrollees. Thus, if caseloads had grown faster
than expected in one state and slower than expected in another, the basic
grant to the first state would be adjusted upward while the basic grant to
the second was adjusted downward.
The total amount provided in basic grants to the 50 states and the District
of Columbia would remain the same as initially set forth in the statute,
with one exception. HHS would be required to increase the aggregate
amount of the basic grants to cover caseload increases that HHS
determined were generated by an economic slowdown. Any such
increases in the aggregate amount of the basic grants would be
temporary, lasting only as long as the slowdown.
This formulation would have the following effects:
If some states chose, as a matter of policy, to squeeze providers and
benefits harder so they could expand coverage within limited resources,
all other states would find their basic grants reduced to offset the increase
in caseload caused by the states that expanded coverage. This across-the-
board reduction in basic grants would penalize states that chose the
approach of providing more substantial benefits for those who are most
vulnerable.
37
The federal umbrella payments would fail to protect against the
cumulative effect of caseload growth, despite the clear understanding of
many governors that these payments should provide such protection. A
simple example illustrates the problem. Suppose a state's basic grant
includes a growth factor sufficient to cover a beneficiary population that
grows at two percent per year. But suppose actual beneficiary growth
turns out to be three percent per year. After the first year, the state would
be covering one percent more beneficiaries than expected; after the second
year, two percent, and so on. By 2002, the seventh year, the state caseload
would be seven percent above expectations. But the umbrella payment in
2002 would only cover one percent higher costs - the difference between the
expected two percent growth from 2001 to 2002 and the actual three
percent growth.
HHS' annual redistribution of basic grant funds might make up for a
portion of the six percent shortfall in this case, but almost certainly would
not make up for most of this shortfall. To make up for all of this shortfall,
the state in question would need to have received a six percent increase in
its basic grant by 2002 beyond the basic grant level the statute originally
envisioned for the state. For the state to have received a basic grant
increase of this magnitude, the national Medicaid caseload would need to
have remained at or below initial expectations during the 1996-2002
period. If the total amount of funding available for basic grants remained
fixed at the levels set in the statute (as would occur in the absence of an
economic slowdown), while the national caseload rose beyond
expectations, the basic grants to the states experiencing caseload increases
would not increase sufficiently to absorb these caseload increases fully
into the state's "base."
Under the governors' plan, national caseload is likely to exceed initial
expectations for two reasons. First, public policy in many states seems to
favor expanded coverage, paid for by managed care efficiencies and,
perhaps, restricted benefit packages. Second, the incentive for states to
"game" the umbrella payments by enrolling many new, artificially cheap
enrollees would likely lead to greater-than-anticipated caseload growth.
In short, under this interpretation of the governors' plan, states with
unexpected caseload increases are likely to get inadequate fiscal
protection, with the protection becoming more inadequate with each
passing year.
HHS would have considerable leeway in deciding the overall, national
level of the basic grants as well as the level for each state. HHS would be
38
required to estimate what portion of caseload growth resulted from
economic weakness. There is no objective, mechanical way to determine
what portion of caseload changes result from the business cycle. HHS
would have to use its judgment in this regard. That judgment would
affect total federal Medicaid costs as well as each state's Medicaid grant
level.
The inability to predict state-by-state caseload growth rates with perfect
precision would not be quite as costly to the federal government as
described under the "Heads I Win; Tails You Lose" section of this report.
That is because under this interpretation of the governors' proposal,
errors made in developing the original predictions of state caseloads
would not compound over time. States that reduce their caseload and
reap a windfall would get a smaller windfall. The windfall also might be
of shorter duration.
39
APPENDIX B: DATA AND METHODOLOGY
The CBO forecast of federal Medicaid spending from 1996 through 2002 is used
as the projection of federal Medicaid expenditures under current law. The
corresponding amount of total state baseline spending during this period is derived
from the CBO forecast of federal Medicaid spending. Total state baseline spending is
then divided among states in proportion to the state-by-state baseline spending
projections that the Urban Institute issued in December 1995. 21
It is assumed that gross federal Medicaid reductions would be made across-the-
board and that the special payments for undocumented aliens (see footnote 13) would
be distributed as specified in the reconciliation bill. An alternative assumption - that
the level of grants (other than for undocumented aliens) would be increased across-the-
board relative to the grant levels that would be made under the reconciliation bill,
rather than reduced across-the-board relative to baseline levels - leads to aggregate
results virtually identical to those presented here. Under the alternative approach, the
state-by-state distribution of the cuts would differ, but the total amount of cuts would
not.
Finally, the amounts assumed for the level of federal Medicaid reductions in
2002 under the President's budget and the latest Republican budget offer are taken
from documents prepared by the Administration and the House and Senate Budget
Committees. These documents show the level of federal Medicaid savings in 2002
under these budget plans.
21
See The Impact of the "Medigrant" Plan on Federal Payments to State, December 1995, prepared by John
Holohan and David Liska of the Urban Institute for the Kaiser Commission on the Future of Medicaid,
Table 7.
41
Appendix C: Federal Medical Assistance Percentages (FMAPs)*
(The percentage of Medicaid costs that the federal and state governments pay)
Current law, 1996 est.
Reconciliation bill
NGA with 40% maximum**
Federal
State
Federal
State
Federal
State
Average
56.7%
43.3%
63.0%
37.0%
62.2%
37.8%
Alabama
69.9%
30.2%
72.9%
27.1%
69.9%
30.2%
Alaska
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Arizona
65.9%
34.2%
65.9%
34.2%
65.9%
34.2%
Arkansas
73.6%
26.4%
74.1%
25.9%
73.6%
26.4%
California
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Colorado
52.4%
47.6%
60.0%
40.0%
60.0%
40.0%
Connecticut
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Delaware
50.3%
49.7%
60.0%
40.0%
60.0%
40.0%
DC
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Florida
55.8%
44.2%
65.7%
34.3%
60.0%
40.0%
Georgia
61.9%
38.1%
61.9%
38.1%
61.9%
38.1%
Hawaii
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Idaho
68.8%
31.2%
68.8%
31.2%
68.8%
31.2%
Illinois
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Indiana
62.6%
37.4%
62.6%
37.4%
62.6%
37.4%
Iowa
64.2%
35.8%
64.2%
35.8%
64.2%
35.8%
Kansas
59.0%
41.0%
60.0%
40.0%
60.0%
40.0%
Kentucky
70.3%
29.7%
74.7%
25.3%
70.3%
29.7%
Louisiana
71.9%
28.1%
77.1%
22.9%
71.9%
28.1%
Maine
63.3%
36.7%
65.2%
34.8%
63.3%
36.7%
Maryland
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Massachusetts
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
Michigan
56.8%
43.2%
61.2%
38.8%
60.0%
40.0%
Minnesota
53.9%
46.1%
60.0%
40.0%
60.0%
40.0%
Mississippi
78.1%
21.9%
80.7%
19.3%
78.1%
21.9%
Missouri
60.1%
39.9%
60.5%
39.5%
60.1%
39.9%
Montana
69.4%
30.6%
69.4%
30.6%
69.4%
30.6%
Nebraska
59.5%
40.5%
60.0%
40.0%
60.0%
40.0%
Nevada
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
New Hampshire
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
New Jersey
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
New Mexico
72.9%
27.1%
73.0%
27.1%
72.9%
27.1%
New York
50.0%
50.0%
60.0%
40.0%
60.0%
40.0%
North Carolina
64.6%
35.4%
64.6%
35.4%
64.6%
35.4%
North Dakota
69.1%
30.9%
69.1%
30.9%
69.1%
30.9%
Ohio
60.2%
39.8%
60.2%
39.8%
60.2%
39.8%
Oklahoma
69.9%
30.1%
69.9%
30.1%
69.9%
30.1%
Oregon
61.0%
39.0%
61.0%
39.0%
61.0%
39.0%
Pennsylvania
52.9%
47.1%
60.0%
40.0%
60.0%
40.0%
Rhode Island
53.8%
46.2%
60.0%
40.0%
60.0%
40.0%
South Carolina
70.8%
29.2%
74.0%
26.0%
70.8%
29.2%
South Dakota
66.7%
33.3%
66.7%
33.3%
66.7%
33.3%
Tennessee
65.6%
34.4%
69.6%
30.4%
65.6%
34.4%
Texas
62.3%
37.7%
62.8%
37.3%
62.3%
37.7%
Utah
73.2%
26.8%
73.2%
26.8%
73.2%
26.8%
Vermont
60.9%
39.1%
60.9%
39.1%
60.9%
39.1%
Virginia
51.4%
48.6%
60.0%
40.0%
60.0%
40.0%
Washington
50.2%
49.8%
60.0%
40.0%
60.0%
40.0%
West Virginia
73.3%
26.7%
75.8%
24.2%
73.3%
26.7%
Wisconsin
59.7%
40.3%
60.0%
40.0%
60.0%
40.0%
Wyoming
59.7%
40.3%
60.0%
40.0%
60.0%
40.0%
* GAO estimate of State FMAPs. The national average is weighted in accordance with the Urban Institute's December 1995 estimate of
the state-by-state distribution of baseline Medicaid spending from 1996 through 2002.
** It is unclear whether the governors' plan envisions that the matching rates be those which are shown in these two columns or those
shown in the columns titled "reconciliation bill;" see page 16.
43
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MEMORANDUM
TO: Distribution
July 27, 1995
FR: Chris Jennings and Jen Klein
RE: Medicare and Medicaid State by State Analysis
Attached is the complete set of state by state analysis on the Republican Medicare and
Medicaid cuts that we are releasing tomorrow. We are coordinating closely with
communications within the White House and HHS to get widespread distribution, particularly
in regional press. In addition, we are coordinating closely with Legislative Affairs,
Intergovernmental Affairs, Public Liaison, Political Affairs, and Cabinet Affairs to distribute
this document.
Highlights of this state by state report include:
Total Medicare beneficiary out-of-pocket increases over the next seven years
for individuals and couples
The number of people who would lose their Medicaid coverage
The combined effect of loss of funding resulting from Republican Medicare
and Medicaid cuts
Over one-third of these combined cuts will come from just four states:
California ($54 billion), Florida ($38 billion), New York ($37 billion), and
Texas ($28 billion).
This information can be distributed beginning tomorrow. We hope to get as much
amplification on this story tomorrow; please understand that any contacts with the press
should highlight the release of this report.
If you have any questions, please do not hesitate to call me at 456-5560.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
THE UNITED STATES
The Republican Budget Resolution Conference Agreement:
Impact of Medicare and Medicaid Cuts on States
Republicans are proposing to cut more than $450 billion from health care between
1996 and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. Over one-
third of these cuts would come from just four states: California ($54 billion), Florida
($38 billion), New York ($37 billion), and Texas ($28 billion). In combination, these cuts
are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay
at least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
These cuts will affect all states, but some states more so than others. States such as
Florida and Texas, where there are high numbers of beneficiaries, will be particularly hard
hit. California, Florida, Texas, New York and Pennsylvania, for instance, will bear more
than 40% of all the Medicare cuts. On a per beneficiary basis, Massachusetts,
Tennessee, Alabama and Rhode Island would also have higher than average increases in
the out-of-pocket costs.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services,
provider payments, and eliminate coverage for 8.8 million children, elderly, and disabled
individuals in 2002, according to the Urban Institute. The only way to avoid these reductions
in coverage would be for states to increase their spending by 40% -- by raising property or
sales taxes, or cutting other critical state spending.
The Medicaid cuts have enormously different impacts on states. While all states will
see about a one-third reduction in their Federal Medicaid spending, states with high growth --
for any reason, including recessions or an increase in their elderly population -- will be
particularly hard hit. New York and California alone will bear 20% of the total Medicaid
cuts, while West Virginia, Florida, and Georgia will see the largest reductions as a
proportion of their current Federal grant.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of
plans without imposing any new Medicare beneficiary cost-sharing increases. His Medicare
savings, which are less than half ($124 billion) of the Republican proposal ($270 billion),
come from health care providers and through a major new fraud and abuse initiative.
Effects of the Republicans' Balanced Budget Proposal (Conference Agreement)
Loss of Medicare and Medicaid Funding by State
(Dollars in Millions, Fiscal Years)
2002
1996-2002
Medicare
Medicaid
Combined
Medicare
Medicaid
Combined
U.S.
71,000
51,150*
122,150*
270,000
171,803*
441,803*
Alabama
1,661
542
2,203
5,890
1,733
7,623
Alaska
42
121
163
166
429
595
Arizona
1,247
792
2,039
4,626
2,672
7,297
Arkansas
525
696
1,221
2,108
2,444
4,553
California
9,893
5,477
15,371
36,371
18,032
54,403
Colorado
959
475
1,434
3,434
1,654
5,088
Connecticut
1,042
486
1,528
3,968
1,423
5,391
Delaware
235
98
334
865
331
1,196
District of Columbia
1,197
259
1,456
3,778
863
4,641
Florida
7,789
2,704
10,493
28,098
9,691
37,789
Georgia
1,737
1,692
3,429
6,519
6,093
12,612
Hawaii
362
161
523
1,253
572
1,825
Idaho
125
160
285
520
542
1,062
Illinois
2,218
1,847
4,065
9,078
6,120
15,197
Indiana
1,312
1,290
2,602
5,092
4,269
9,361
lowa
414
384
798
1,751
1,235
2,986
Kansas
697
228
925
2,650
663
3,313
Kentucky
809
1,121
1,930
3,227
3,828
7,056
Louisiana
1,330
1,511
2,841
5,062
5,151
10,213
Maine
193
236
429
807
675
1,483
Maryland
891
800
1,691
3,664
2,702
6,366
Massachusetts
2,569
1,305
3,874
9,464
4,291
13,755
Michigan
1,827
1,778
3,605
7,540
5,935
13,476
Minnesota
1,264
687
1,951
4,534
2,134
6,669
Mississippi
563
705
1,268
2,232
2,457
4,689
Missouri
1,280
433
1,714
5,073
1,235
6,308
Montana
131
211
342
538
766
1,303
Nebraska
283
224
506
1,126
728
1,854
Nevada
533
157
690
1,861
516
2,377
New Hampshire
244
40
284
924
51
975
New Jersey
1,940
1,188
3,129
7,727
3,701
11,428
New Mexico
208
389
598
844
1,352
2,196
New York
4,481
5,863
10,345
18,058
18,924
36,982
North Carolina
1,810
1,830
3,640
6,749
6,764
13,513
North Dakota
133
118
251
537
382
919
Ohio
2,161
2,124
4,285
8,868
7,088
15,956
Oklahoma
633
642
1,275
2,558
2,250
4,808
Oregon
844
516
1,360
3,092
1,838
4,930
Pennsylvania
3,785
1,906
5,691
15,053
6,123
21,175
Rhode Island
403
264
667
1,451
861
2,312
South Carolina
923
672
1,594
3,361
2,281
5,642
South Dakota
128
123
251
516
396
912
Tennessee
1,989
1,455
3,444
7,248
5,090
12,338
Texas
4,539
3,316
7,855
16,991
11,135
28,126
Utah
277
302
580
1,061
1,035
2,096
Vermont
88
99
187
356
318
673
Virginia
879
798
1,677
3,625
2,844
6,469
Washington
818
1,053
1,870
3,289
3,719
7,008
West Virginia
394
919
1,313
1,586
3,321
4,907
Wisconsin
765
883
1,648
3,182
2,903
6,085
Wyoming
41
72
112
179
245
424
MEDICARE ESTIMATES: Source: US DHHS. Savings estimates from Conference Agreement. as scored off of the CBO Medicare baseline
Based on historical state share of Medicare outlays, trended forward with growth in the states' share of outlays.
Estimates based on Medicare outlays by location of service delivery. Thus, certain state estimates may be affected by
part-year residency and state border crossing to obtain care (e.g., Florida & Minnesota).
MEDICAID ESTIMATES: Source: The Urban Institute. Assumes growth rates of 7.2% in 1996, 6.8% in 1997. and 4% for 1998 and subsequent years.
Estimates do not correspond exactly to the CBO estimates of this proposals since the Urban Institute has independently constructed the states' baselines.
. Because the Medicaid estimates are not based on the CBO baseline. the totals are not equal to those in the Conference Agreement
Effects of the Republican Resolution Agreement's Medicare Proposal On States
Losses by State Under the Proposal Relative to the President's Proposal
(Excluding Premium Extenders in President's Budget, Fiscal years)
Increased Out-of-Pocket Cost Per Beneficiary
(Increase in dollars per beneficiary)
1996-2002
US
$2,825
Alabama
3,775
Alaska
1,350
Arizona
2,775
Arkansas
1,875
California
4,100
Colorado
3,000
Connecticut
3,250
Delaware
3,350
District of Columbia
NA
Florida
4,400
Georgia
3,025
Hawaii
3,050
Idaho
1,075
Illinois
2,200
Indiana
2,400
lowa
1,300
Kansas
2,850
Kentucky
2,075
Louisiana
3,575
Maine
1,350
Maryland
2,275
Massachusetts
4,300
Michigan
2,100
Minnesota
2,900
Mississippi
2,175
Missouri
2,425
Montana
1,425
Nebraska
1,700
Nevada
3,000
New Hampshire
2,175
New Jersey
2,625
New Mexico
1,225
New York
2,825
North Carolina
2,400
North Dakota
2,025
Ohio
2,000
Oklahoma
2,000
Oregon
2,525
Pennsylvania
2,975
Rhode Island
3,650
South Carolina
2,425
South Dakota
1,625
Tennessee
3,850
Texas
3,125
Utah
1,925
Vermont
1,475
Virginia
1,500
Washington
1,675
West Virginia
1,800
Wisconsin
1,500
Wyoming
800
Puerto Rico
875
Source: US DHHS. Savings estimates from Conference Agreement, as scored off of the CBO Medicare baseline. Rounded to the nearest $25
Variation in the costs per beneficiary across states reflects factors such as: (1) practice pattern differences,
(2) cost differences; (3) differences in health status and the number of very old persons in a state:
and (4) differences in the supply of health care providers.
NOTES: Assumes that increases in beneficiary out-of-pocket costs (e.g., premiums and coinsurance) are equal to 50% of the total cuts.
Based on historical state share of Medicare outlays & enrollment, trended forward with growth in the states' share of outlays & enrollment
Estimates based on Medicare outlays by location of service delivery. Thus, certain state estimates may be affected by
part-year residency and state border crossing to obtain care (e.g., Florida & Minnesota).
State border crossing makes the District of Columbia estimates unreliable.
REVISED: July 12, 1995
States' Losses Under a Medicaid Block Grant, 1996 - 2002
Republicans' Balanced Budget Proposal (Conference Agreement)
(Dollars in Millions, Fiscal Years)
Losses in Dollars (1996-2002)
Losses as a Percent of Spending in 2002
U.S.
(171,803)
U.S.
-28.9%
New York
(18,924)
West Virginia
-35.5%
California
(18,032)
Florida
-35.2%
Texas
(11,135)
Georgia
-34.5%
Florida
(9,691)
New Mexico
-33.9%
Ohio
(7,088)
North Carolina
-33.8%
North Carolina
(6,764)
Arkansas
-33.4%
Pennsylvania
(6,123)
Montana
-33.2%
Illinois
(6,120)
Virginia
-32.8%
Georgia
(6,093)
Arizona
-32.5%
Michigan
(5,935)
Kentucky
-32.4%
Louisiana
(5,151)
Alaska
-32.3%
Tennessee
(5,090)
Tennessee
-31.7%
Massachusetts
(4,291)
Hawaii
-31.7%
Indiana
(4,269)
Maryland
-31.6%
Kentucky
(3,828)
Utah
-31.5%
Washington
(3,719)
Oregon
-31.3%
New Jersey
(3,701)
Colorado
-31.2%
West Virginia
(3,321)
Oklahoma
-31.2%
Wisconsin
(2,903)
Washington
-31.1%
Virginia
(2,844)
District of Columbia
-30.7%
Maryland
(2,702)
California
-30.5%
Arizona
(2,672)
Delaware
-30.5%
Mississippi
(2,457)
Wyoming
-30.3%
Arkansas
(2,444)
Mississippi
-30.1%
South Carolina
(2,281)
Indiana
-29.9%
Oklahoma
(2,250)
Illinois
-29.8%
Minnesota
(2,134)
Michigan
-29.7%
Oregon
(1,838)
Idaho
-29.4%
Alabama
(1,733)
Texas
-29.2%
Colorado
(1,654)
Nevada
-29.0%
Connecticut
(1,423)
Wisconsin
-28.8%
New Mexico
(1,352)
Ohio
-28.3%
Missouri
(1,235)
South Dakota
-27.8%
lowa
(1,235)
Massachusetts
-27.7%
Utah
(1,035)
Nebraska
-27.3%
District of Columbia
(863)
Vermont
-27.0%
Rhode Island
(861)
Pennsylvania
-26.8%
Montana
(766)
lowa
-26.6%
Nebraska
(728)
New York
-26.6%
Maine
(675)
Rhode Island
-26.3%
Kansas
(663)
North Dakota
-25.8%
Hawaii
(572)
Minnesota
-25.4%
Idaho
(542)
Louisiana
-24.6%
Nevada
(516)
South Carolina
-24.4%
Alaska
(429)
New Jersey
-23.3%
South Dakota
(396)
Alabama
-21.8%
North Dakota
(382)
Maine
-21.6%
Delaware
(331)
Kansas
-21.1%
Vermont
(318)
Connecticut
-20.7%
Wyoming
(245)
Missouri
-16.5%
New Hampshire
(51)
New Hampshire
-6.3%
Source: The Urban Institute. Assumes growth rates of 7.2% in 1996, 6.8% in 1997. and 4% for 1998 and subsequent years.
Estimates do not correspond exactly to the CBO estimates of this proposals since the Urban Institute has
independently constructed the states' baselines.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
ALABAMA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Alabama
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Alabama by $8 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Alabama's over 630,000 Medicare beneficiaries would pay as much as
$3,775 more in premiums and copayments over the seven years; couples would pay at least
$7,550 more. Overall, the state of Alabama would lose $2 billion in Medicare funding in
2002, and $6 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Alabama would lose $542 million in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 22% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
544,000 recipients. According to this study, these cuts would mean that Alabama could
have to cut off coverage for 102,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
ALASKA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Alaska
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Alaska by $595 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Alaska's over 32,000 Medicare beneficiaries would pay as much as $1,350
more in premiums and copayments over the seven years; couples would pay at least $2,700
more. Overall, the state of Alaska would lose $42 million in Medicare funding in 2002, and
$166 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Alaska would lose $121 million in Federal Medicaid funding in
2002 and $429 million over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
69,000 recipients. According to this study, these cuts would mean that Alaska could have to
cut off coverage for 22,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
ARIZONA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Arizona
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Arizona by $7 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Arizona's over 577,000 Medicare beneficiaries would pay as much as $2,775
more in premiums and copayments over the seven years; couples would pay at least $5,550
more. Overall, the state of Arizona would lose $1 billion in Medicare funding in 2002, and
$5 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Arizona would lose $792 million in Federal Medicaid funding in
2002 and $3 billion over the seven years, a reduction of 33% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
510,000 recipients. According to this study, these cuts would mean that Arizona could have
to cut off coverage for 110,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
ARKANSAS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Arkansas
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Arkansas by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Arkansas's over 416,000 Medicare beneficiaries would pay as much as
$1,875 more in premiums and copayments over the seven years; couples would pay at least
$3,750 more. Overall, the state of Arkansas would lose $525 million in Medicare funding in
2002, and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Arkansas would lose $696 million in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 33% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
340,000 recipients. According to this study, these cuts would mean that Arkansas could
have to cut off coverage for 122,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
CALIFORNIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on California
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to California by $54 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of California's over 3.6 million Medicare beneficiaries would pay as much as
$4,100 more in premiums and copayments over the seven years; couples would pay at least
$8,200 more. Overall, the state of California would lose $10 billion in Medicare funding in
2002, and $36 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of California would lose $5 billion in Federal Medicaid funding in
2002 and $18 billion over the seven years, a reduction of 31% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
5.0 million recipients. According to this study, these cuts would mean that California could
have to cut off coverage for 1.2 million recipients in 2002, likely adding them to the ranks
of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
COLORADO
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Colorado
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Colorado by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Colorado's over 409,000 Medicare beneficiaries would pay as much as
$3,000 more in premiums and copayments over the seven years; couples would pay at least
$6,000 more. Overall, the state of Colorado would lose $959 million in Medicare funding in
2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Colorado would lose $475 billion in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 31% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
289,000 recipients. According to this study, these cuts would mean that Colorado could
have to cut off coverage for 97,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
CONNECTICUT
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Connecticut
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Connecticut by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Connecticut's over 497,000 Medicare beneficiaries would pay as much as
$3,250 more in premiums and copayments over the seven years; couples would pay at least
$6,500 more. Overall, the state of Connecticut would lose $1 billion in Medicare funding in
2002, and $4 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Connecticut would lose $486 million in Federal Medicaid
funding in 2002 and $1 billion over the seven years, a reduction of 21% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 354,000 recipients. According to this study, these cuts would mean that
Connecticut could have to cut off coverage for 74,000 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
DELAWARE
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Delaware
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Delaware by $1 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Delaware's over 98,000 Medicare beneficiaries would pay as much as $3,350
more in premiums and copayments over the seven years; couples would pay at least $6,700
more. Overall, the state of Delaware would lose $235 million in Medicare funding in 2002,
and $865 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Delaware would lose $98 million in Federal Medicaid funding in
2002 and $331 million over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
75,000 recipients. According to this study, these cuts would mean that Delaware could
have to cut off coverage for 21,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
DISTRICT OF COLUMBIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on the District of Columbia
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to the District of Columbia by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Overall, the District of Columbia would lose $1 billion in Medicare funding in 2002,
and $4 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the District of Columbia would lose $259 million in Federal Medicaid
funding in 2002 and $863 million over the seven years, a reduction of 31% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the
District's current 127,000 recipients. According to this study, these cuts would mean that
District of Columbia could have to cut off coverage for 20,000 recipients in 2002, likely
adding them to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
FLORIDA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Florida
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Florida by $38 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Florida's over 2.6 million Medicare beneficiaries would pay as much as
$4,400 more in premiums and copayments over the seven years; couples would pay at least
$8,800 more. Overall, the state of Florida would lose $8 billion in Medicare funding in
2002, and $28 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Florida would lose $3 billion in Federal Medicaid funding in
2002 and $10 billion over the seven years, a reduction of 35% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.7 million recipients. According to this study, these cuts would mean that Florida could
have to cut off coverage for 706,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
GEORGIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Georgia
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Georgia by $13 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Georgia's over 811,000 Medicare beneficiaries would pay as much as $3,025
more in premiums and copayments over the seven years; couples would pay at least $6,050
more. Overall, the state of Georgia would lose $2 billion in Medicare funding in 2002, and
$7 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Georgia would lose $2 billion in Federal Medicaid funding in
2002 and $6 billion over the seven years, a reduction of 35% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.1 million recipients. According to this study, these cuts would mean that Georgia could
have to cut off coverage for 383,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
HAWAII
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Hawaii
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Hawaii by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Hawaii's over 146,000 Medicare beneficiaries would pay as much as $3,050
more in premiums and copayments over the seven years; couples would pay at least $6,100
more. Overall, the state of Hawaii would lose $362 million in Medicare funding in 2002,
and $1 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Hawaii would lose $161 million in Federal Medicaid funding in
2002 and $572 million over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
121,000 recipients. According to this study, these cuts would mean that Hawaii could have
to cut off coverage for 36,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
IDAHO
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Idaho
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Idaho by $1 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Idaho's over 146,000 Medicare beneficiaries would pay as much as $1,075
more in premiums and copayments over the seven years; couples would pay at least $2,150
more. Overall, the state of Idaho would lose $125 million in Medicare funding in 2002, and
$520 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Idaho would lose $160 million in Federal Medicaid funding in
2002 and $542 million over the seven years, a reduction of 29% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
110,000 recipients. According to this study, these cuts would mean that Idaho could have
to cut off coverage for 34,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
ILLINOIS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Illinois
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Illinois by $15 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Illinois's over 1.6 million Medicare beneficiaries would pay as much as
$2,200 more in premiums and copayments over the seven years; couples would pay at least
$4,400 more. Overall, the state of Illinois would lose $2 billion in Medicare funding in
2002, and $9 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Illinois would lose $2 billion in Federal Medicaid funding in
2002 and $6 billion over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.4 million recipients. According to this study, these cuts would mean that Illinois could
have to cut off coverage for 274,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
INDIANA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Indiana
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Indiana by $9 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Indiana's over 813,000 Medicare beneficiaries would pay as much as $2,400
more in premiums and copayments over the seven years; couples would pay at least $4,800
more. Overall, the state of Indiana would lose $1 billion in Medicare funding in 2002, and
$5 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Indiana would lose $1 billion in Federal Medicaid funding in
2002 and $4 billion over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
605,000 recipients. According to this study, these cuts would mean that Indiana could have
to cut off coverage for 112,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
IOWA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Iowa
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Iowa by $3 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Iowa's over 472,000 Medicare beneficiaries would pay as much as $1,300
more in premiums and copayments over the seven years; couples would pay at least $2,600
more. Overall, the state of Iowa would lose $414 million in Medicare funding in 2002, and
$2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Iowa would lose $384 million in Federal Medicaid funding in
2002 and $1 billion over the seven years, a reduction of 27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
303,000 recipients. According to this study, these cuts would mean that Iowa could have to
cut off coverage for 69,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
KANSAS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Kansas
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Kansas by $3 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Kansas's over 380,000 Medicare beneficiaries would pay as much as $2,850
more in premiums and copayments over the seven years; couples would pay at least $5,700
more. Overall, the state of Kansas would lose $697 million in Medicare funding in 2002,
and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Kansas would lose $228 million in Federal Medicaid funding in
2002 and $663 million over the seven years, a reduction of 21% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
252,000 recipients. According to this study, these cuts would mean that Kansas could have
to cut off coverage for 40,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
KENTUCKY
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Kentucky
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Kentucky by $7 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Kentucky's over 575,000 Medicare beneficiaries would pay as much as
$2,075 more in premiums and copayments over the seven years; couples would pay at least
$4,150 more. Overall, the state of Kentucky would lose $809 million in Medicare funding
in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Kentucky would lose $1 billion in Federal Medicaid funding in
2002 and $4 billion over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
638,000 recipients. According to this study, these cuts would mean that Kentucky could
have to cut off coverage for 171,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
LOUISIANA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Louisiana
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Louisiana by $10 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Louisiana's over 572,000 Medicare beneficiaries would pay as much as
$3,575 more in premiums and copayments over the seven years; couples would pay at least
$7,150 more. Overall, the state of Louisiana would lose $1 billion in Medicare funding in
2002, and $5 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Louisiana would lose $2 billion in Federal Medicaid funding in
2002 and $5 billion over the seven years, a reduction of 25% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
778,000 recipients. According to this study, these cuts would mean that Louisiana could
have to cut off coverage for 154,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MAINE
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Maine
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Maine by $1 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Maine's over 198,000 Medicare beneficiaries would pay as much as $1,350
more in premiums and copayments over the seven years; couples would pay at least $2,700
more. Overall, the state of Maine would lose $193 million in Medicare funding in 2002, and
$807 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Maine would lose $236 million in Federal Medicaid funding in
2002 and $675 million over the seven years, a reduction of 22% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
177,000 recipients. According to this study, these cuts would mean that Maine could have
to cut off coverage for 34,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MARYLAND
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Maryland
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Maryland by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Maryland's over 591,000 Medicare beneficiaries would pay as much as
$2,275 more in premiums and copayments over the seven years; couples would pay at least
$4,550 more. Overall, the state of Maryland would lose $891 million in Medicare funding
in 2002, and $4 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Maryland would lose $800 million in Federal Medicaid funding
in 2002 and $3 billion over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
415,000 recipients. According to this study, these cuts would mean that Maryland could
have to cut off coverage for 116,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MASSACHUSETTS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Massachusetts
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Massachusetts by $14 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Massachusetts's over 923,000 Medicare beneficiaries would pay as much as
$4,300 more in premiums and copayments over the seven years; couples would pay at least
$8,600 more. Overall, the state of Massachusetts would lose $3 billion in Medicare funding
in 2002, and $9 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Massachusetts would lose $1 billion in Federal Medicaid
funding in 2002 and $4 billion over the seven years, a reduction of 28% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 710,000 recipients. According to this study, these cuts would mean that
Massachusetts could have to cut off coverage for 210,000 recipients in 2002, likely adding
them to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MICHIGAN
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Michigan
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Michigan by $13 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Michigan's over 1.3 million Medicare beneficiaries would pay as much as
$2,100 more in premiums and copayments over the seven years; couples would pay at least
$4,200 more. Overall, the state of Michigan would lose $2 billion in Medicare funding in
2002, and $8 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Michigan would lose $2 billion in Federal Medicaid funding in
2002 and $6 billion over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.2 million recipients. According to this study, these cuts would mean that Michigan could
have to cut off coverage for 215,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MINNESOTA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Minnesota
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Minnesota by $7 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Minnesota's over 623,000 Medicare beneficiaries would pay as much as
$2,900 more in premiums and copayments over the seven years; couples would pay at least
$5,800 more. Overall, the state of Minnesota would lose $1 billion in Medicare funding in
2002, and $5 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Minnesota would lose $687 million in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 25% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
426,000 recipients. According to this study, these cuts would mean that Minnesota could
have to cut off coverage for 88,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MISSISSIPPI
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Mississippi
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Mississippi by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Mississippi's over 390,000 Medicare beneficiaries would pay as much as
$2,175 more in premiums and copayments over the seven years; couples would pay at least
$4,350 more. Overall, the state of Mississippi would lose $563 million in Medicare funding
in 2002, and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Mississippi would lose $705 million in Federal Medicaid
funding in 2002 and $2 billion over the seven years, a reduction of 30% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 537,000 recipients. According to this study, these cuts would mean that Mississippi
could have to cut off coverage for 141,000 recipients in 2002, likely adding them to the
ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MISSOURI
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Missouri
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Missouri by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Missouri's over 823,000 Medicare beneficiaries would pay as much as
$2,425 more in premiums and copayments over the seven years; couples would pay at least
$4,850 more. Overall, the state of Missouri would lose $1 billion in Medicare funding in
2002, and $5 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Missouri would lose $433 million in Federal Medicaid funding
in 2002 and $1 billion over the seven years, a reduction of 17% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
669,000 recipients. According to this study, these cuts would mean that Missouri could
have to cut off coverage for 83,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
MONTANA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Montana
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Montana by $1 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Montana's over 127,000 Medicare beneficiaries would pay as much as
$1,425 more in premiums and copayments over the seven years; couples would pay at least
$2,850 more. Overall, the state of Montana would lose $131 million in Medicare funding in
2002, and $538 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Montana would lose $211 million in Federal Medicaid funding
in 2002 and $766 million over the seven years, a reduction of 33% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
96,000 recipients. According to this study, these cuts would mean that Montana could have
to cut off coverage for 27,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NEBRASKA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Nebraska
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Nebraska by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Nebraska's over 247,000 Medicare beneficiaries would pay as much as
$1,700 more in premiums and copayments over the seven years; couples would pay at least
$3,400 more. Overall, the state of Nebraska would lose $283 million in Medicare funding in
2002, and $1 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Nebraska would lose $224 million in Federal Medicaid funding
in 2002 and $728 million over the seven years, a reduction of 27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
164,000 recipients. According to this study, these cuts would mean that Nebraska could
have to cut off coverage for 41,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NEVADA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Nevada
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Nevada by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Nevada's over 182,000 Medicare beneficiaries would pay as much as $3,000
more in premiums and copayments over the seven years; couples would pay at least $6,000
more. Overall, the state of Nevada would lose $533 million in Medicare funding in 2002,
and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Nevada would lose $157 million in Federal Medicaid funding in
2002 and $516 million over the seven years, a reduction of 29% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
95,000 recipients. According to this study, these cuts would mean that Nevada could have
to cut off coverage for 26,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NEW HAMPSHIRE
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on New Hampshire
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to New Hampshire by $975 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of New Hampshire's over 152,000 Medicare beneficiaries would pay as much
as $2,175 more in premiums and copayments over the seven years; couples would pay at
least $4,350 more. Overall, the state of New Hampshire would lose $244 million in
Medicare funding in 2002, and $924 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of New Hampshire would lose $40 million in Federal Medicaid
funding in 2002 and $51 million over the seven years, a reduction of 6% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 88,000 recipients. According to this study, these cuts would mean that New
Hampshire could have to cut off coverage for 1,100 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NEW JERSEY
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on New Jersey
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to New Jersey by $11 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of New Jersey's over 1.2 million Medicare beneficiaries would pay as much as
$2,625 more in premiums and copayments over the seven years; couples would pay at least
$5,250 more. Overall, the state of New Jersey would lose $2 billion in Medicare funding in
2002, and $8 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of New Jersey would lose $1 billion in Federal Medicaid funding in
2002 and $4 billion over the seven years, a reduction of 23% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
790,000 recipients. According to this study, these cuts would mean that New Jersey could
have to cut off coverage for 166,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NEW MEXICO
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on New Mexico
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to New Mexico by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of New Mexico's over 205,000 Medicare beneficiaries would pay as much as
$1,225 more in premiums and copayments over the seven years; couples would pay at least
$2,450 more. Overall, the state of New Mexico would lose $208 million in Medicare
funding in 2002, and $844 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of New Mexico would lose $389 million in Federal Medicaid
funding in 2002 and $1 billion over the seven years, a reduction of 34% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 268,000 recipients. According to this study, these cuts would mean that New
Mexico could have to cut off coverage for 80,000 recipients in 2002, likely adding them to
the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NEW YORK
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on New York
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to New York by $37 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of New York's over 2.6 million Medicare beneficiaries would pay as much as
$2,825 more in premiums and copayments over the seven years; couples would pay at least
$5,650 more. Overall, the state of New York would lose $4 billion in Medicare funding in
2002, and $18 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of New York would lose $6 billion in Federal Medicaid funding in
2002 and $19 billion over the seven years, a reduction of 27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
2.9 million recipients. According to this study, these cuts would mean that New York could
have to cut off coverage for 645,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NORTH CAROLINA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on North Carolina
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to North Carolina by $14 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of North Carolina's over 999,000 Medicare beneficiaries would pay as much as
$2,400 more in premiums and copayments over the seven years; couples would pay at least
$4,800 more. Overall, the state of North Carolina would lose $2 billion in Medicare
funding in 2002, and $7 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of North Carolina would lose $2 billion in Federal Medicaid
funding in 2002 and $7 billion over the seven years, a reduction of 34% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 985,000 recipients. According to this study, these cuts would mean that North
Carolina could have to cut off coverage for 455,000 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
NORTH DAKOTA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on North Dakota
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to North Dakota by $919 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of North Dakota's over 102,000 Medicare beneficiaries would pay as much as
$2,025 more in premiums and copayments over the seven years; couples would pay at least
$4,050 more. Overall, the state of North Dakota would lose $133 million in Medicare
funding in 2002, and $537 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of North Dakota would lose $118 million in Federal Medicaid
funding in 2002 and $382 million over the seven years, a reduction of 26% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 63,000 recipients. According to this study, these cuts would mean that North
Dakota could have to cut off coverage for 18,000 recipients in 2002, likely adding them to
the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
OHIO
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Ohio
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Ohio by $16 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Ohio's over 1.6 million Medicare beneficiaries would pay as much as $2,000
more in premiums and copayments over the seven years; couples would pay at least $4,000
more. Overall, the state of Ohio would lose $2 billion in Medicare funding in 2002, and $9
billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Ohio would lose $2 billion in Federal Medicaid funding in 2002
and $7 billion over the seven years, a reduction of 28% in the year 2002 alone, according to
the Urban Institute. This will have a devastating impact on the state's current 1.5 million
recipients. According to this study, these cuts would mean that Ohio could have to cut off
coverage for 292,000 recipients in 2002, likely adding them to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
OKLAHOMA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Oklahoma
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Oklahoma by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Oklahoma's over 479,000 Medicare beneficiaries would pay as much as
$2,000 more in premiums and copayments over the seven years; couples would pay at least
$4,000 more. Overall, the state of Oklahoma would lose $633 million in Medicare funding
in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Oklahoma would lose $642 million in Federal Medicaid funding
in 2002 and $2 billion over the seven years, a reduction of 31% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
391,000 recipients. According to this study, these cuts would mean that Oklahoma could
have to cut off coverage for 125,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
OREGON
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Oregon
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Oregon by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Oregon's over 460,000 Medicare beneficiaries would pay as much as $2,525
more in premiums and copayments over the seven years; couples would pay at least $5,050
more. Overall, the state of Oregon would lose $844 million in Medicare funding in 2002,
and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Oregon would lose $516 million in Federal Medicaid funding in
2002 and $2 billion over the seven years, a reduction of 31% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
411,000 recipients. According to this study, these cuts would mean that Oregon could have
to cut off coverage for 118,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
PENNSYLVANIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Pennsylvania
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Pennsylvania by $21 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Pennsylvania's over 2.1 million Medicare beneficiaries would pay as much
as $2,975 more in premiums and copayments over the seven years; couples would pay at
least $5,950 more. Overall, the state of Pennsylvania would lose $4 billion in Medicare
funding in 2002, and $15 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Pennsylvania would lose $2 billion in Federal Medicaid funding
in 2002 and $6 billion over the seven years, a reduction of 27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
1.3 million recipients. According to this study, these cuts would mean that Pennsylvania
could have to cut off coverage for 308,000 recipients in 2002, likely adding them to the
ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
RHODE ISLAND
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Rhode Island
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Rhode Island by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Rhode Island's over 166,000 Medicare beneficiaries would pay as much as
$3,650 more in premiums and copayments over the seven years; couples would pay at least
$7,300 more. Overall, the state of Rhode Island would lose $403 million in Medicare
funding in 2002, and $1 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Rhode Island would lose $264 million in Federal Medicaid
funding in 2002 and $861 million over the seven years, a reduction of 26% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 115,000 recipients. According to this study, these cuts would mean that Rhode
Island could have to cut off coverage for 51,000 recipients in 2002, likely adding them to the
ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
SOUTH CAROLINA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on South Carolina
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to South Carolina by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of South Carolina's over 495,000 Medicare beneficiaries would pay as much as
$2,425 more in premiums and copayments over the seven years; couples would pay at least
$4,850 more. Overall, the state of South Carolina would lose $923 million in Medicare
funding in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of South Carolina would lose $672 million in Federal Medicaid
funding in 2002 and $2 billion over the seven years, a reduction of 24% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 486,000 recipients. According to this study, these cuts would mean that South
Carolina could have to cut off coverage for 149,000 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
SOUTH DAKOTA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on South Dakota
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to South Dakota by $912 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of South Dakota's over 116,000 Medicare beneficiaries would pay as much as
$1,625 more in premiums and copayments over the seven years; couples would pay at least
$3,250 more. Overall, the state of South Dakota would lose $128 million in Medicare
funding in 2002, and $516 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of South Dakota would lose $123 million in Federal Medicaid
funding in 2002 and $396 million over the seven years, a reduction of 28% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 72,000 recipients. According to this study, these cuts would mean that South
Dakota could have to cut off coverage for 19,000 recipients in 2002, likely adding them to
the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
TENNESSEE
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Tennessee
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Tennessee by $12 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Tennessee's over 753,000 Medicare beneficiaries would pay as much as
$3,850 more in premiums and copayments over the seven years; couples would pay at least
$7,700 more. Overall, the state of Tennessee would lose $2 billion in Medicare funding in
2002, and $7 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Tennessee would lose $1 billion in Federal Medicaid funding in
2002 and $5 billion over the seven years, a reduction of 32% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
939,000 recipients. According to this study, these cuts would mean that Tennessee could
have to cut off coverage for 246,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
TEXAS
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Texas
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Texas by $28 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Texas's over 2.0 million Medicare beneficiaries would pay as much as
$3,125 more in premiums and copayments over the seven years; couples would pay at least
$6,250 more. Overall, the state of Texas would lose $5 billion in Medicare funding in 2002,
and $17 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Texas would lose $3 billion in Federal Medicaid funding in 2002
and $11 billion over the seven years, a reduction of 29% in the year 2002 alone, according
to the Urban Institute. This will have a devastating impact on the state's current 2.5
million recipients. According to this study, these cuts would mean that Texas could have to
cut off coverage for 687,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
UTAH
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Utah
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Utah by $2 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Utah's over 182,000 Medicare beneficiaries would pay as much as $1,925
more in premiums and copayments over the seven years; couples would pay at least $3,850
more. Overall, the state of Utah would lose $277 million in Medicare funding in 2002, and
$1 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Utah would lose $302 million in Federal Medicaid funding in
2002 and $1 billion over the seven years, a reduction of 31% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
157,000 recipients. According to this study, these cuts would mean that Utah could have to
cut off coverage for 53,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
VERMONT
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Vermont
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Vermont by $673 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Vermont's over 81,000 Medicare beneficiaries would pay as much as $1,475
more in premiums and copayments over the seven years; couples would pay at least $2,950
more. Overall, the state of Vermont would lose $88 million in Medicare funding in 2002,
and $356 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Vermont would lose $99 million in Federal Medicaid funding in
2002 and $318 million over the seven years, a reduction of 27% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
90,000 recipients. According to this study, these cuts would mean that Vermont could have
to cut off coverage for 20,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
VIRGINIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Virginia
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Virginia by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Virginia's over 798,000 Medicare beneficiaries would pay as much as $1,500
more in premiums and copayments over the seven years; couples would pay at least $3,000
more. Overall, the state of Virginia would lose $879 million in Medicare funding in 2002,
and $4 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Virginia would lose $798 million in Federal Medicaid funding in
2002 and $3 billion over the seven years, a reduction of 33% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
643,000 recipients. According to this study, these cuts would mean that Virginia could
have to cut off coverage for 236,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
WASHINGTON
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Washington
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Washington by $7 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Washington's over 671,000 Medicare beneficiaries would pay as much as
$1,675 more in premiums and copayments over the seven years; couples would pay at least
$3,350 more. Overall, the state of Washington would lose $818 million in Medicare funding
in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Washington would lose $1 billion in Federal Medicaid funding
in 2002 and $4 billion over the seven years, a reduction of 31% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
668,000 recipients. According to this study, these cuts would mean that Washington could
have to cut off coverage for 183,000 recipients in 2002, likely adding them to the ranks of
the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
WEST VIRGINIA
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on West Virginia
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to West Virginia by $5 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of West Virginia 's over 325,000 Medicare beneficiaries would pay as much as
$1,800 more in premiums and copayments over the seven years; couples would pay at least
$3,600 more. Overall, the state of West Virginia would lose $394 million in Medicare
funding in 2002, and $2 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of West Virginia would lose $919 million in Federal Medicaid
funding in 2002 and $3 billion over the seven years, a reduction of 35% in the year 2002
alone, according to the Urban Institute. This will have a devastating impact on the state's
current 367,000 recipients. According to this study, these cuts would mean that West
Virginia could have to cut off coverage for 140,000 recipients in 2002, likely adding them
to the ranks of the uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
WISCONSIN
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Wisconsin
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Wisconsin by $6 billion.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Wisconsin's over 753,000 Medicare beneficiaries would pay as much as
$1,500 more in premiums and copayments over the seven years; couples would pay at least
$3,000 more. Overall, the state of Wisconsin would lose $765 million in Medicare funding
in 2002, and $3 billion over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Wisconsin would lose $883 million in Federal Medicaid funding
in 2002 and $3 billion over the seven years, a reduction of 29% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
474,000 recipients. According to this study, these cuts would mean that Wisconsin could
have to cut off coverage for 94,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
THE WHITE HOUSE
Office of Media Affairs
FOR IMMEDIATE RELEASE
Contact: 202/456-7150
July 28, 1995
WYOMING
The Republican Budget Resolution Conference Agreement:
Impact of the Medicare and Medicaid Cuts on Wyoming
Republicans are proposing to cut more than $450 billion from health care between 1996
and 2002 -- $270 billion from Medicare and $182 billion from Medicaid. In combination, these
cuts are more than four times anything ever enacted. Most of the $270 billion in Medicare cuts
would not be necessary without the Republicans' $245 billion tax cut for well-off Americans.
Over the seven-year period, the combined Medicare and Medicaid cuts of the Republicans
would reduce Federal health care dollars to Wyoming by $424 million.
Medicare
Nationally, the $270 billion in Medicare cuts means that the average beneficiary would
pay at least $2,825 more in premiums and copayments over seven years; couples would pay at
least another $5,650. Under a recent House Republican proposal, in 2002 alone an average
beneficiary in a nursing home would face an increase of at least $1,400. Beneficiaries using
home health care services would pay on average an additional $1,700 in 2002.
Each of Wyoming's over 59,000 Medicare beneficiaries would pay as much as $800
more in premiums and copayments over the seven years; couples would pay at least $1,600
more. Overall, the state of Wyoming would lose $41 million in Medicare funding in 2002,
and $179 million over seven years.
Medicaid
The Medicaid cuts proposed by Republicans would force states to slash services, provider
payments, and eliminate coverage for 8.8 million children, elderly, and disabled individuals in
2002, according to the Urban Institute. The only way to avoid these reductions in coverage
would be for states to increase their spending by 40% -- by raising property or sales taxes, or
cutting other critical state spending.
Overall, the state of Wyoming would lose $72 million in Federal Medicaid funding
in 2002 and $245 million over the seven years, a reduction of 30% in the year 2002 alone,
according to the Urban Institute. This will have a devastating impact on the state's current
51,000 recipients. According to this study, these cuts would mean that Wyoming could
have to cut off coverage for 15,000 recipients in 2002, likely adding them to the ranks of the
uninsured.
The President's Balanced Budget Proposal
The President shows how it is possible to balance the budget, assure that the Medicare
Trust Fund remains solvent for at least another decade, and expand benefits and choice of plans
without imposing any new Medicare beneficiary cost increases. His Medicare savings, which are
less than half ($124 billion) of the Republican proposal ($270 billion), come from health care
providers and through a major new fraud and abuse initiative.
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
Lake medicaid
SPECAL
REPORT
A Publication of Families USA, February, 1996
What Does the National Governors'
Association Proposal Mean for Medicaid
Beneficiaries?
OVERVIEW
O
n February 6, 1996, the National Governors' Association (NGA)
unanimously approved a compromise proposal to restructure the
Medicaid program. This proposal has been hailed as a breakthrough
that could breathe new life into the stalled federal budget negotiations between
the President and the Congress. Medicaid reform has been one of the most
contentious issues between congressional leaders and the President. Thus, the
compromise proposal raised hopes that a federal budget agreement is
achievable.
The Governors' proposal reflects the
positions of only one of the interest groups in
All guarantees of
the Medicaid program controversy-the
Governors. Not surprisingly, the Governors seek
meaningful coverage
to maximize federal funding while granting
will be eliminated
themselves the flexibility to cut their own
Medicaid budgets. At the same time, the
Governors want much more control over the
most needy citizens." But a review of the plan
program's operations. In asserting those
belies that assertion. Significant numbers of very
interests, however, the Governors' proposal
vulnerable groups will lose existing or future
significantly weakens the program's historic
coverage-including people with disabilities,
Families
protections for low- and moderate-income
seniors, older children, and families receiving
people who depend on Medicaid for their health
public assistance. All guarantees of meaningful
care. It will also enable state governments to
coverage will be eliminated. New and
FOUNDATION
evade their fiscal obligations under the program,
unaffordable cost-sharing requirements may be
resulting in significant cutbacks of service to
imposed. Federal standards for quality of health
THE CONSUMER VOICE
FOR HEALTH CARE
program beneficiaries.
care will be nullified. And the ability of program
1334 G Street, NW
The NGA's description of the proposal
beneficiaries to enforce remaining rights will be
Washington, DC 20005
posits that it "guarantees health care to our
weakened.
file medicard
TO:
Hillary Rodham Clinton
Melanne Verveer
FROM:
Jennifer Klein J.K.
RE:
National Governors' Association Medicaid Resolution
DATE:
2/9/96
The National Governors' Association (NGA) Medicaid resolution that passed on
Tuesday has received a great deal of attention from the media, the Hill, and the health care
provider and advocacy community. As a whole, the "right" has given this proposal
widespread praise and has raised concern only about the resolution's financing provisions.
The "left" has been extremely critical of the proposal, charging that the provisions on
benefits, eligibility and enforcement strip the Medicaid program of its "guarantee."
This memo addresses the parts of the NGA proposal that relate to the guarantee.
(While there are numerous outstanding issues, including how the resolution addresses quality
standards, nursing home standard enforcement, and spousal impoverishment, we thought it
was most important to focus on the fundamental structural issues first.) The memo also
describes reactions from the Governors, the Hill and the interest groups.
NGA staff will brief White House and HHS staff on Monday evening to clarify their
policy and to outline the process they have put in place to resolve remaining policy
differences between Republican and Democratic Governors. We also understand that Leon
plans to hold an internal meeting to discuss the resolution and that a meeting with the
President may follow.
BACKGROUND
From the beginning of the Medicaid debate, the Administration has consistently taken
the position that it is possible to constrain program growth while still maintaining Medicaid's
guarantee of coverage to the elderly, the disabled, children and pregnant women. The
Medicaid portion of the President's balanced budget proposal provides unprecedented
flexibility for states while maintaining the guarantee and saving $59 billion over seven years.
Over the past several months, the Governors have attempted to hammer out a
compromise Medicaid position to further the budget negotiations. The Democratic Governors
worked tirelessly to move the Republicans from their insistence on a block grant, and the
Republicans hesitantly agreed to a new funding formula that assures that federal dollars
increase with enrollment increases during economic downturns. The Democratic Governors
rightly believe that their success in getting the Republicans to agree to a guaranteed funding
stream is a significant step forward. To achieve this victory, however, the outnumbered
Democrats were apparently forced to give in on provisions that may well undermine the
federal guarantee.
FOUR PARTS OF THE GUARANTEE UNDER MEDICAID
There are four elements that make up the Medicaid guarantee: financing, eligibility,
benefits, and enforcement.
Financing Guarantee. The NGA proposal seems to ensure that there will be
adequate funding to maintain the guarantee by including an "umbrella" financing
mechanism. This mechanism automatically provides additional federal support as
economic downturns produce enrollment increases. Interestingly, the umbrella only
increases, while under current law, federal financing rises and falls with changes in
coverage and state contributions.
However, the NGA proposal lowers the required state match to from 50% to 40%
(inserted at the last second for Governor Pataki). This could significantly decrease
overall Medicaid spending. HHS estimates that the $85 billion in federal savings
would translate into $290 billion in total spending reductions if all states matched at
the minimum level. In addition, the state may be able to substitute state dollars with
revenue raised through provider taxes and donations. Since this is "borrowed" money,
it would effectively reduce states' real spending on Medicaid. We do not yet know
how CBO will score these financing changes.
Eligibility Guarantee. The NGA proposal seems to retain coverage for most groups
who are currently eligible but has some notable exceptions. It repeals the phase-in of
coverage by 2002 for poor children between the ages of 13 and 18 that was signed
into law by President Bush in 1990. (According to the Children's Defense Fund, about
three million children would lose coverage.) In addition, the proposal allows states to
define disability, subject to federal approval, instead of requiring all states to meet a
minimum federal definition, as is now the law. This could result in widespread
variation in eligibility determinations among states and, in the minds of some, could
threaten the guarantee of eligibility for people with disabilities.
Benefits Guarantee. The NGA proposal leaves in place the current, nationally
defined list of covered benefits for mandatory coverage groups. However, the
proposal seems to eliminate the requirement that all medically necessary services
within the benefit categories be provided. It also gives states unlimited discretion to
determine the amount, duration and scope of services within benefit categories and
permits states to offer different benefits to different groups of beneficiaries or in
different areas of the state. For example, under these provisions, states could limit the
number of hospital days per year provided to children, even if a doctor decides that
the care is medically necessary. States could also decide to cover five days of hospital
services for disabled children but only two days for people with AIDS. Finally, they
could chose to cover a particular benefit in some areas of the state, but not for
example, on an Indian reservation. Although the resolution's language seems fairly
clear, it is hard to believe that the Governors, particularly the Democrats, really
2
intended to go this far on both mandatory and optional benefits.
The proposal also redefines the treatment portion of EPSDT (Early and Periodic
Screening, Diagnosis and Treatment) so that "states need not cover all Medicaid
optional services for children." They have not yet resolved what treatment would be
covered.
Enforcement of the Guarantee. The NGA proposal eliminates a federal cause of
action by Medicaid beneficiaries. Claims brought by individuals to enforce their rights
under Medicaid would be limited to state courts and state law. Only the Secretary of
Health and Human Services could bring an action in federal court on behalf of
Medicaid beneficiaries.
Attached is a more detailed description of the issues raised by the NGA proposal to
eliminate the federal cause of action. The most significant problem is that, under this
proposal, eligibility will vary between states because state courts will interpret the law
differently. In addition, fewer remedies are available under state law than under
federal law. The Secretary of Health and Human Services will be unable to litigate
adequately on behalf of individuals because the significant new administrative burden
that will be placed on the Department will likely cause delays and because the only
remedy available to the Secretary is the withdrawal of funds (which will make matters
worse for the recipients in the state).
REACTION TO THE NGA PROPOSAL
Governors' Position: The six Governors on the Medicaid Policy Group (Romer,
Chiles, Miller, Thompson, Engler and Leavitt) are working with NGA staff to clarify
the Medicaid resolution and to resolve remaining disagreements.
As with any hastily drafted document, there are a number of provisions that
Democratic Governors either did not know about or are uncomfortable with. It is not
clear that the Democratic Governors intended to repeal Title XIX (Medicaid)
completely. In addition, Governor Chiles was apparently unaware that the resolution
repeals restrictions on the use of provider taxes and donations. Governor Romer has
told us he is uncomfortable with the disability language and the reduction in state
matching. And it seems that all the Democrats are uneasy with dropping the phase-in
of 13 to 18 year old kids.
Hill Position: Most Republicans, through the RNC and comments by the Speaker,
are strongly embracing the NGA proposal. They claim that it is a virtual mirror-image
of their Medigrant proposal. Republicans are apparently planning to draft a bill
quickly and dare us to criticize it. There are rumors that they may attach their
interpretation of the NGA resolution to the debt ceiling bill.
3
The Republican reaction has fueled the suspicions of the Democrats and, with few
exceptions, there has been a generally negative reaction to the NGA proposal. In the
House, the "base" Democrats have charged that the proposal offers no guarantee and
may even be a block grant in sheep's clothing. Congressman Stenholm and
Congressman Dingell are concerned about the lack of state accountability, the
reduction in state match, and the adequacy of the legal enforcement provisions. They
argue that it is not unreasonable to expect federal eligibility requirements, standards
and enforcement in return for a large federal investment.
On the Senate side, Senator Breaux has called for hearings so he can fully understand
the implications of the proposal. Senator Chafee has raised significant concerns and
has suggested that it appears to require federal maintenance of effort and little to no
accountability. Clearly, however, both Senators Breaux and Chafee want to keep the
Medicaid discussions alive for the sake of a budget deal and will continue to avoid
being overly critical in public.
Interest Groups: There has been a strong negative reaction from the groups,
including the American Hospital Association, the American Academy of Pediatrics, the
Catholic Health Association, the Children's Defense Fund, the Alzheimers' Association,
and AIDS and other disability groups. These groups feel that enactment of a proposal
like the Governors' resolution would end the guarantee and significantly increase the
number of uninsured. The Office of Public Liaison is concerned because the President
has won the trust of many groups by taking a strong stand on Medicaid; a reversal
may be difficult to repair.
CONCLUSION
As you can see, we have real concerns. Things may change, however, as discussions
with the NGA continue. We will keep you informed.
PRIVATE RIGHT OF ACTION
A Federal Private Right of Action is Important to Maintaining the Guarantee. The
NGA proposal (and the Congressional conference report) have eliminated any federal cause of
action by Medicaid beneficiaries. Claims brought by individuals to enforce their rights under
Medicaid would be limited to state courts and state law. Only the Secretary of Health and
Human Services could bring an action in federal court on behalf of Medicaid beneficiaries.
Both Republican and Democratic Governors want to reduce the number of Medicaid cases
filed. In addition, they do not want court decisions from federal courts in other states to have
any effect on how they run their Medicaid programs. While, under their proposal, cases
heard in other states' courts would no longer have precedential value, it is not likely that
fewer cases would be filed; they would simply be filed in state court.
Since the inception of the Medicaid program, a person eligible for Medicaid has had both a
guarantee of access to certain services and the right to enforce this commitment. We believe
that preservation of the federal cause of action for individuals to enforce Medicaid eligibility
assures this guarantee.
Consistent Interpretation. Those aspects of the Medicaid program that are common
to all states -- like eligibility -- should be consistently interpreted and administered.
The basic guarantee of who is covered should be uniform across the country; without
a federal cause of action, it will not be. For example, under current interpretations, a
woman who has a miscarriage is considered "pregnant" and therefore eligible for
services for complications arising from the miscarriage. Under the NGA proposal, if a
state improperly denied those services, she could no longer go to federal court to
enforce her right. The issue would instead be litigated in fifty states; in some states,
she would receive care while in others she might not.
Significant Limitation of Remedies. Most state laws establish higher hurdles for
plaintiffs and provide less relief than federal law. Under most state statutes that allow
courts to review administrative actions, there is no de novo review (the record before
the court is limited to information considered by the agency) and relief is granted only
when a claimant can show that the agency action was arbitrary and capricious, not
merely wrong. In addition, most state laws do not allow beneficiaries to recover
attorneys' fees, making it more difficult for them to afford legal counsel.
The NGA proposal (and the conference report) maintains a right to sue in federal court
through the Secretary of Health and Human Services. However, this poses three
problems: (1) the Secretary can sue only if a state is in "substantial noncompliance"
DI
-- a much higher standard than exists today; (2) the Health Care Financing
Administration will become involved in greater numbers of lawsuits and face
significant new administrative burdens; and (3) it is unclear what remedies are
available. If the only remedy that the Secretary can seek is the withdrawal of federal
funds, this would cause significant harm to the beneficiaries that the Secretary is
supposed to represent (and might even make this remedy unusable).
Departure from Other Federal Statutes. Eliminating the federal cause of action
would single out Medicaid as the one federal statute that could not be enforced in
federal court by its intended beneficiaries. Such an unprecedented step would be seen
as a signal of second-class status and would set off a massive reaction from
beneficiary groups and their allies.
Elimination of Remedies under Civil Rights Law. While it is not clear that the
NGA intends to go this far, the conference agreement precludes the right to enforce
civil rights laws. Protection against discrimination in state programs has been
established under the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the
Age Discrimination Act of 1975 and the Americans with Disabilities Act of 1990. If
this is what the Governors intended, the civil rights community is likely to be very
concerned.
The President's Proposal Increases Flexibility While Maintaining the Guarantee. The
President's plan eliminates causes of action by providers over payment rates by repealing the
Boren Amendment. This removes state officials' greatest source of concern over litigation
and the most frequent basis for cases filed in federal court.
The proposal maintains current law on private enforcement of beneficiary rights under
Medicaid. To address the Governors' concerns, eligibility claims could be separated from
some benefits claims. On eligibility issues, which are most closely linked to the concept of a
guarantee, individuals would retain their current right to bring suits in federal court.
However, individuals would be required to exhaust a state administrative process before filing
in court. Most claims involving benefits would be heard only in state courts. A benefits
claim could be heard in federal court only if there were an allegation that the state plan or a
contract between the state and a provider violated a provision of federal law.
6
02/06/96 16:59
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TALKING POINTS ON GOVERNORS' MEDICAID POLICY RESOLUTION
We are pleased that the Governors' have passed a policy resolution that affirms our
national commitment to the guarantee under Medicaid. We are also pleased that they
have continued the financial partnership between the federal government and the states
that allows Medicaid funding to follow increases in enrollment.
As Congress considers this resolution, we need to make sure that that guarantee is
real.
There must be a national guarantee to meaningful benefits.
There must be national guidelines for eligibility that protect those who are
eligible under current law. For example, under current law, coverage for three
million children between 13 and 17 is being phased in. That commitment
should continue.
And we must preserve adequate enforcement to assure this guarantee.
02/06/96
17:00
004
CONCERNS/OUTSTANDING QUESTIONS
ABOUT THE NGA MEDICAID RESOLUTION
Eligibility concerns include: The repeal of the current law's phase-in for coverage of
about 3 million children age 13-17; the devolution of the "disability" definition to the
states; the limitation to "frail" elderly population seems to not include all elderly who
are currently eligible; and the elimination of the required coverage of premiums for
low-income Medicare beneficiaries between 100-120 percent of poverty is repealed.
Benefit concerns include: The total discretion given to states to alter the
amount/duration/scope of services; the repeal of the current law's comparability and
statewideness requirement that ensure that recipients in particular groups or locations
are not discriminated against; the apparent elimination of any defined benefit
package for currently optional populations; and the vague redefinition of the "T" in
the EPSDT children's health benefit.
Enforcement concerns include: The state-based right of action process advocated
by the Governors (and whether it will work to effectively ensure the guarantee).
Financing concerns include: The exclusion of pregnant women and children, as well
as the medically needy, from the Federally-financed "umbrella" pool payments; the
inclusion in the base formula of the allowance that states can reduce their matching
Medicaid rate -- the result producing an additional $200 billion reduction in state
Medicaid spending over seven years, bringing the total Federal/State cut to $290
billion; the allowance for states to, once again, tax health care providers to help
finance their state match; allowing for provider taxes will likely push up the cost of
the program that CBO scores.
Quality concerns include: The adequacy of the quality protections for plans under
Medicaid, such as HMOs and other managed care plan; the apparent repeal of the
state-based enforcement of Ronald Reagan's Federal nursing home standards. (The
difference between them and us has always come down to definition and enforcement.)
medicand for
THE WHITE HOUSE
WASHINGTON
February 19, 1996
MEMORANDUM FOR THE PRESIDENT
FROM:
Carol Rasco, Laura Tyson and Alice Rivlin
SUBJECT: National Governors' Association Medicaid Resolution
This memo highlights our major concerns with the National Governors' Association (NGA)
Medicaid resolution. It summarizes these concerns, outlines our current position with regard
to each issue, suggests some possible fall-back positions, and provides you with a reading of
the Democratic Governors' positions on each of these issues. It also includes a summary of
the Hill and Interest Group reaction to the resolution. We thought you might find this to be
useful background information for our Medicaid meeting with you tomorrow morning.
Background
Governors Chiles, Miller, Romer, Engler, Leavitt, and Thompson are coming back in town
tomorrow. They are scheduled to testify at Medicaid hearings on Wednesday and Thursday
before the House Commerce and Senate Finance Committees. The Governors' testimony will
focus on the recently adopted National Governors' Association resolution, and they will
attempt to begin to fill in some of the details behind this resolution. Next week, Secretary
Shalala has been invited to appear before the Senate Finance Committee to outline the
Administration's response to the NGA resolution.
The six Governors will also meet for three hours tomorrow evening to prepare for their
Wednesday hearing. The Democratic Governors want to continue to work closely with us
and will meet with us before meeting with the Republican Governors. They rightly believe
they achieved a significant victory by getting the Republicans to agree to a new financing
mechanism that ensures that "dollars follow people." They also believe that there are a
number of provisions that were vaguely drafted, which have been interpreted by many as
extremely problematic (such as the NGA benefits section), that can be "clarified" through the
normal NGA policy development process. Having said this, the Democratic Governors also
acknowledge that they are a number of significant flaws in the NGA agreement that should be
addressed.
1
Where We Agree with NGA
Before outlining our differences and concerns with the NGA resolution, it is important to
summarize briefly where we have significant agreement. Your Medicaid reforms include at
least 12 NGA-endorsed flexibility recommendations, including arguably the three most
important structural changes:
(1)
The establishment of a new financing mechanism that links and constrains
federal financing to enrollment through the use of an open-ended "umbrella"
that assures that "dollars follow people" and that states are protected from
economic downturns;
(2)
The repeal of the Boren amendment and other federal provider
reimbursement requirements; and
(3)
The liberation of states from the waiver process for:
Managed care
Home and community-based care
Coverage expansions up to 150 percent of poverty
Outstanding Issues Related to NGA Resolution
There are three sets of issues that will be debated in the legislative process: (1) the
"guarantee"; (2) second tier issues; and (3) the Title XIX debate.
The "Guarantee." Those issues that are directly related to the Medicaid "guarantee"
(financing, eligibility, benefits and enforcement) will demand most of your attention
and are the focus of this memo.
Second Tier, But Critical Issues. There are "second tier" issues, such as nursing
home standard enforcement, financial protections for families (like spousal
impoverishment), and managed care quality assurance, that will require Administration
attention should negotiations progress. These issues helped us personalize the
Republican Medicaid cuts and they are viewed as critical by most Democrats.
(For example, Senator Pryor feels strongly about the nursing home enforcement issue.)
The Title XIX Debate. Finally, the Republican desire to repeal title XIX and
substitute a new Medicaid title raises a host of concerns. Drafting a brand new title
for Medicaid in the limited time we have left in this Congress would inevitably lead to
unforeseen legal, policy and political consequences. This would include having to
determine how to deal with case law -- such as what is the definition of "medical
necessity" -- that has developed over the past 30 years. Perhaps most importantly,
taking this route would place us in an untenable bargaining position; we would have to
give "chits" just to "reinstate" provisions that are current law.
2
THE NGA RESOLUTION AND THE GUARANTEE: ADMINISTRATION POSITIONS
There are four elements that make up the Medicaid guarantee: financing, eligibility, benefits,
and enforcement. Each of these elements is inextricably linked to the others and changes to
any one of them must be carefully constructed to avoid undermining the foundation of the
guarantee and the program. The following outlines the primary concerns we have with the
proposal and summarizes current and possible fall-back Administration positions on these
issues.
(1)
Financing Concerns:
The NGA proposal uses a financing mechanism that is different from ours but that
also assures that dollars follow increases in enrollment. However, it has the following
problems:
States are guaranteed their base formula allotment even if they choose to
reduce coverage. This provision -- drafted for states like Michigan -- is a
significant departure from the historical Medicaid federal/state partnership,
where federal financing support rises and falls with changes in coverage.
Many states can reduce their state Medicaid matching requirement.
This provision -- hastily inserted for Governor Pataki -- would significantly
decrease overall Medicaid spending OR significantly increase Federal spending.
It would reduce the maximum state match from 50 percent to 40 percent. If
federal spending is capped and all states matched at their minimum levels, the
matching rate change would reduce total Medicaid spending by an additional
$140 billion over seven years (on top of the already assumed $85 billion in
federal savings and $65 billion in state savings). This could lead to large
estimates of coverage loss unless the major eligibility and benefit protections
mentioned later in this TeTo are assured. If federal spending were not
capped, the cost-shift resulting from the lower state match would totally offset
the $85 billion in federal savings.
States could substitute state tax dollars with revenue raised through
provider taxes and donations. Since this is "borrowed" money, it would
effectively reduce states' real spending on Medicaid. Because this would make
it easier to raise state matching dollars, CBO (and OMB) would likely conclude
that this provision would also significantly reduce Federal savings.
Administration Position: Our CBO-scored per capita cap approach to Medicaid cost
containment has a "dollars follow people" mechanism that is more direct than the
NGA umbrella and does not include any of the problems mentioned above. We would
keep the current matching formula, but propose that a national commission be
established to make recommendations on how to address perceived inequities.
3
Possible Fall-Back Position: The Republican Governors are likely to refuse an
Administration-like per capita cap financing mechanism. We may be able to live with
a NGA-like financing approach if, as the Democratic Governors' intended, it truly
allows dollars to follow people and if the state matching reduction and the provider
tax/donation provisions are fixed. Governors Chiles, Romer, and Miller all have
indicated they share our concerns with these provisions and support our position.
(In fact, the six "Medicaid" Governors never discussed the provider tax and state
matching reduction issues; they were added as last second amendments to the
resolution.)
(2)
Eligibility Concerns:
Repeals current law that phases-in coverage for 1.5 million poor children
between the ages of 13 and 18. OMB estimates a maximum of $6 billion in
federal savings if all states do not phase-in coverage. (This would overtum a
law enacted by President Bush in 1990.)
Allows states to define disability, subject to HHS approval, instead of
requiring all states to meet a minimum federal definition. This proposal
could result in widespread variation in eligibility determinations among states
and could threaten the eligibility guarantee for people with disabilities.
Administration Position: We retain the kids phase-in and use the welfare reform's
approach to address the Governors' concern about disability eligibility abuse. This
gives Governors the option not to designate as "disabled" those persons who are
alcoholics and chemical and substance abusers, as well as tightens the eligibility
definition for children under SSI.
Possible Fall-Back Position: No fall-back for the kids coverage expansion. On
disability, we could limit eligibility for other groups if the Governors can demonstrate
that there have been eligibility abuses. If this compromise is still not acceptable, we
could consider allowing states to define disability, but with much stricter criteria that
the Secretary must use to evaluate designations. (This latter approach needs to be
politically vetted.) The Democratic Governors would probably be fine with either
of these positions, although Governor Romer thinks the states should not be
defining disability eligibility.
(3)
Benefit Concerns:
Eliminates the current "adequacy" requirement for benefits and gives
states unlimited discretion to determine the amount, duration and scope of
services within benefit categories. Under these provisions, the HHS
Secretary would have no legal basis for concluding that a one-day hospital
benefit was insufficient to meet the federal requirement for a hospital benefit.
4
Repeals current statewideness and comparability requirements for optional
benefits. Without these provisions, states could offer different benefits to
different groups of recipients or provide different benefits in different areas of
the state. For example, states could decide to provide a no-deductible/no cap
prescription drug benefit for a disabled person who had a stroke and a drug
benefit with a $500 deductible and a $1,000 cap for a person with AIDS.
May repeal the statewideness and comparability requirements for
mandatory benefits. If this is the case, states could offer 5 months of hospital
services for children and 2 weeks for the disabled.
Redefines the treatment portion of EPSDT (Early and Periodic Screening,
Diagnosis and Treatment) so that states need not cover all Medicaid
optional services for children.
Administration Position: The Administration maintains that these concerns must be
addressed or the national guarantee to benefits is legitimately called into question.
Your proposal retains the current benefit package and protections. On EPSDT, it
clarifies that benefits provided to children under the treatment requirement need not be
given to any other population (under the comparability requirements.)
Possible Fall-Back Position: Maintain the benefits adequacy standard. Maintain
current protections for mandatory benefits, but negotiate significant changes in the
requirements on the optional benefits, including eliminating or significantly liberalizing
current comparability and statewideness requirements. Negotiate further modifications
to the "treatment" requirement within EPSDT, including that the requirement need not
extend beyond a certain age group OR the possibility that the benefits provided need
not exceed the states' optional package. (These are "hot-button" options that would no
doubt have to be carefully rolled out if pursued.) The Democratic Governors
support retention of the "adequacy standard," but -- like the NGA -- have not
yet finalized their position on the other benefit issues.
(4)
Enforcement Concerns:
Eliminates any federal cause of action under Medicaid by beneficiaries,
health care providers and health plans. Claims brought by individuals to
enforce their rights under Medicaid would be limited to state courts and state
law. Only the Secretary of Health and Human Services could bring an action
in federal court on behalf of Medicaid beneficiaries.
There are four major concerns with this proposal. First, the eligibility would
vary between states because state courts would interpret the law differently;
the same person could be covered in one state but not in another. Second,
fewer remedies would be available under state law than under federal law.
Third, Medicaid would be the only federal statute that confers individual rights
that could not be enforced in federal courts by its intended beneficiaries.
5
Finally, the HHS Secretary would be unable to litigate adequately on behalf of
individuals because there would be significant new administrative burdens
placed on the Department and because the only remedy available to the
Secretary would be the withdrawal of funds to the state.
Administration Position: We repeal the Boren amendment and make it clear that
providers have no right to sue over payment rates. We retain current law for
eligibility and benefit claims brought by individuals.
Possible Back-Up Position: In addition to the outright repeal of the Boren
Amendment, we could also eliminate the private right of action by providers and
health plans completely (so that they could no longer sue over provider qualifications
or other issues not related to reimbursement).
On causes of action brought by recipients, we could follow up on a suggestion made
by Governor Chiles and propose separating eligibility claims from some benefit
claims. Under this approach:
There would be no suits by providers health plans over reimbursement rates or
any other issue.
Everyone filing a claim would be required to exhaust administrative remedies.
A recent survey of state Medicaid agencies found that in the 40 states that
responded, less than 5% of fair hearing decisions were appealed to a court. In
California, for example, 4,600 fair hearings were held and less than 1% were
appealed. In Wisconsin, 376 fair hearings were held, and 8 (2%) were
appealed. (Texas Legal Services Center, 1994.)
Most disputes over benefits would be heard in state court. Benefits claims
would only be heard in federal court if there were an allegation that the state
plan or a contract between the state and a provider violated federal law.
Claims brought by individuals over eligibility would be heard in federal court.
Across the country, there were 6 reported cases over eligibility in 1994, 8
in 1993, 6 in 1992 and 8 in 1991. (National Health Law Program, Inc., 1995.)
This is not a high priority issue for the Democratic Governors, and we believe
that they would support our approach. However, they have reported that the
Republican Governors have a philosophical aversion to any Federal right of
action. What is clear from our conversations with the NGA staff, though, is that
the Governors have not focused on this issue in any great detail.
Conclusion
We hope this information is helpful to you in deciding how the Administration should
position itself on the Medicaid front. Attached is a background document on the
congressional and interest group response to the NGA proposal.
6
CONGRESSIONAL AND INTEREST GROUP RESPONSE TO NGA
Hill Response to the NGA Resolution: Most Republicans, through the RNC and
comments by the Speaker, are strongly embracing the NGA proposal. They claim
that it is a virtual mirror-image of their Medigrant proposal. The RNC is literally
passing out paper declaring "victory." The only exception to a complete endorsement
from the Republicans is related to their perception of the financing mechanism. They
are sending signals that they oppose the open-ended nature of it and are suggesting
that they may push for some type of cap. (The Democratic Governors have already
indicated that they would "walk" from the deal if this occurred.)
Republicans appear to want to push a "bipartisanly-supported NGA" bill out and dare
us to criticize it. It is for this reason that they have so quickly scheduled hearings for
this Wednesday and Thursday, and have invited Secretary Shalala to testify next week
before the Finance Committee. Having said this, they are reportedly being responsive
to NGA calls to not prematurely unveil a Republican "NGA Medicaid" bill and risk a
meltdown of the bipartisan agreement. There is no question, however, that they are
(behind the scenes) drafting legislation and attempting to get CBO to score it and it is
not inconceivable that they may introduce something prior to Secretary Shalala's
testimony.
The Republican reaction has fueled the suspicions of the Democrats and, with
extremely few exceptions, there has been a generally negative reaction to the NGA
proposal. The "base" Democrats, like Henry Waxman, have been extremely critical of
the proposal and have charged that it offers no guarantee and may even be a block
grant in sheep's clothing.
Congressman Stenholm and Congressman Dingell were apparently quite disappointed
in the lack of state accountability, the reduction in state match, and raised concerns
about the adequacy of the legal enforcement provisions. They argue that it is not
unreasonable to expect a federally-enforced, national eligibility and standards floor in
return for a large federal investment. To back up their point, their staffs have been
circulating a chart that shows how the coalition proposal would provide $840 billion to
state Medicaid programs, at the same time the states are trying to significantly
decrease their Medicaid expenditures.
On the Senate side, Senator Breaux distanced himself a bit and called for hearings so
he could fully understand the implications of the proposal. His staff reports that
Senator Breaux thought the Democratic Governors were going to be able to "cut a
better deal than they did." On the moderate Republican side of the aisle, Senator
Chafee privately raised concerns about the proposal and suggested it appeared to be
something akin to a federal maintenance of effort with too little accountability.
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Clearly, however, both Senators' Breaux and Chafee want to keep the Medicaid
discussions alive for the sake of a budget deal and will continue to avoid being overly
critical in public. According to Senator Breaux's staff, the primary authors of any
alternative Medicaid bill will likely be Senator Chafee and Senator Graham. Lastly,
there are also reports that Senator Roth's staff is working with the House Commerce
Committee to draft up their own version of the "NGA resolution." Since they have
fairly "green" Medicaid staff who have previously worked at the House Commerce
Committee, it is likely that their bill will largely mirror the House Republican bill.
Interest Group Response to the NGA Resolution: We have received only
negative reactions from the groups, including the unions, the American Hospital
Association, the American Academy of Pediatrics, the Children's Defense Fund, the
Alzheimers' Association and the Consortium for Citizens with Disabilities. The groups,
particularly those who represent children and the disabled, feel that enactment of a
proposal like the Governors' resolution would significantly increase the number of
uninsured and renege on what they believe is a jointly-held commitment with the
Administration to expand, or at least not reduce, the number of insured. The AIDS
groups are particularly concerned because they greatly fear the benefit changes and the
state-by-state definition of disability provision.
The other interest groups are largely staying quiet and waiting to see how we respond
to the likely "clarifying" changes expected to emerge from the NGA over the next
week or so. Some of them are taking this position because they do not want to
undermine our position. Others are holding off because they want to be perceived as
"players" in the upcoming negotiation.
The Office of Public Liaison believes' that your strong stand on Medicaid has built
bridges that extend far beyond the traditional Medicaid constituencies. Public Liaison
believes that significant changes from these groups' perception of our past Medicaid
position may damage this strong alliance and may be difficult to repair.
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