By Barbara Barrett
Kansas City Star
Copyright 2008 Kansas City Star
WASHINGTON — The White House is facing yet another showdown with the Democratic-led Congress.
This time it’s one over tweaks in a set of obscure rules that are understood by almost no one but could affect millions of low-income children and adults.
In the last year, the administration has sought rule changes that would shave $15 billion in the next five years from Medicaid, the much-maligned government program that pays for health care for the nation’s poorest citizens.
The changes have consumed health care leaders across the country. In rural North Carolina, a hospital chief wonders whether she must end newborn deliveries. In Kansas City, Truman Medical Centers Inc. may have to turn away some uninsured patients.
Hospital leaders and local government officials across the U.S. say that if Congress doesn’t act to block the regulations, patients will lose. They say that the changes, which would be enacted around Memorial Day, would force some rural hospitals into the red.
“The sense of urgency is that both the Senate and Congress need to act now,” said John Bluford, the chief executive officer of Truman Medical Centers and the chairman-elect of the National Association of Public Hospitals.
If the rules go through, Truman could lose $37 million next year, almost 9 percent of its budget. Bluford fears he might have to restrict health care for indigent patients to the poorest and those living in Kansas City and surrounding Jackson County.
The Bush administration says the changes come as part of a needed examination of a massive federal program that, they say, has suffered what federal Medicaid chief Dennis Smith called “mission creep.”
“What really is the role of Medicaid? Raising these areas of concern is something everyone should be aware of,” said Smith, the director of the federal Centers for Medicare and Medicaid Services. He pointed to past Government Accountability Office reports showing waste or shoddy oversight in various programs.
Still, around the country, hospital administrators are meeting in boardrooms, calling on lawmakers and worrying about where the money would come from. In Congress, lawmakers are holding hearings and releasing reports about the changes’ impacts.
Sen. Claire McCaskill, a Missouri Democrat who opposes the changes, said Missouri hospitals would lose more than $400 million next year, forcing them to cut services and train fewer doctors.
In North Carolina, half the state’s rural hospitals could run deficits because of the cuts. The state hospital association estimates that up to 3,000 to 6,000 jobs could be lost, up to a thousand of those in rural areas.
For years, the Bush administration occasionally proposed Medicaid changes as part of the president’s annual budget request, but the Republican-led Congress declined to enact his ideas.
With less than a year left in his presidency, Bush doesn’t have Congress, now controlled by Democrats, on his side. But he has the power to change regulations, and he no longer worries about hurting feelings on Capitol Hill. Many of the proposals came in the past year.
The regulations would cut payments for educating doctors, for rehabilitation, for children’s health programs and for general Medicaid reimbursements. They’re complex and aren’t understood even by those who are charged with caring for residents.
Congress imposed a moratorium on two of the rules last year. The first would change the definition of a “public” hospital and lower reimbursements to some hospitals. The second would cut contributions to teaching hospitals for the education of medical residents. The congressional stopgap expires May 25.
The cuts come as part of a larger effort by the federal Centers for Medicare and Medicaid Services to pare its costs.