By Shirley Lin | Special to AsianWeek
Widening budget deficits — the largest since World War II — and surging health care costs have prompted officials in nearly all 50 states to perform surgery on Medicaid, the federal program for low-income Americans. But Asian Pacific American health advocates say targeting the program will eliminate a critical safety net for working-poor communities and jeopardize the services local clinics are committed to providing for the underserved.
The expansion of a popular dental clinic for APAs in San Francisco’s North East Medical Services (NEMS) program, for example, may be shelved according to Linda Bien, acting chief executive of the 32-year-old community health clinic. Officials at NEMS project the medical center will lose 8,000 dental visits, or $1 million, on its newly expanded dental clinic in the next year if Gov. Gray Davis’ widely-watched Medicaid overhaul is approved.
The majority of NEMS patients have Medicaid, but the California legislature is considering lowering the Medicaid eligibility ceiling from 100 percent of the federal poverty level to 61 percent (about $10,000 a year for a family of three). If effective, the cuts will render nearly half a million residents ineligible for Medi-Cal, the state’s version of the program. Fourteen other states have announced plans to reduce Medicaid spending by restricting eligibility.
According to Sheila Robello, policy analyst at the Association of Asian Pacific Community Health Organizations, “A lot of the health centers applied for and received grants to expand the services, but the state governments are cutting the services after they’ve developed the infrastructure. They won’t be able to keep those services open.”
The most common strategies to rein in Medicaid costs include reducing covered benefits, restricting eligibility, freezing or reducing reimbursement rates to doctors and hospitals, and imposing limits on sales of prescription drugs. In a recent survey of state Medicaid officials by the Kaiser Commission on Medicaid and the Uninsured, 49 states and the District of Columbia said they planned to or had already cut Medicaid spending for 2003.
Nationwide, states are trying to address a $60 billion shortfall, with California’s shortfall alone estimated to be $35 billion. To address the country’s second-largest state deficit, New York Gov. George Pataki last week proposed $1 billion in Medicaid spending cuts, but has elaborated on few details. Although falling tax revenues and the national recession are the major culprits of current fiscal gaps, cuts to health care and education are perennial budget fixes for governors and lawmakers. Community advocates believe putting the well-being of disenfranchised groups in peril is short-sighted.
“Medicaid eligibility will be restricted, but we will see more and more uninsured people on the rolls,” Robello predicts. The uninsured, currently a class of more than 41 million Americans, are typically those families whose incomes are too high for Medicaid, but too low to afford private insurance.
The cuts will deal an especially hard blow to providers at community health centers, whose patients are traditionally from low-income, minority and uninsured populations. Funding for the uninsured patients that seek services from these local clinics comes from fixed block grants from the government, whereas payments for treating patients with Medicaid or Medicare come directly from the federal programs.
“We’ll have to take another look at the services and reorganize our priorities, or decide which types of services we will no longer provide,” says Bien. For example, NEMS may offer routine dental cleaning, but may no longer be able to afford to provide dentures. “We want these cuts to have the least impact on the patient. But I doubt they can seek care anywhere else.”
Many community health centers are already reporting a higher influx of uninsured patients. And advocates predict a rise among APAs and other underinsured groups seeking last-ditch care in emergency rooms.
“The cuts will decrease access to preventative care,” says Jan Liu, policy analyst for the Asian & Pacific Islander American Health Forum. “You’ll see more improper use of emergency rooms, which cost a lot more and are less effective. Any cuts in medical coverage of low-income populations means their hardships will increase.”
Also on the chopping block are “optional services” in the Medicaid program, categories of care that are left up to the states to include in their healthcare programs. In Washington, Gov. Gary Locke proposed to reduce Medicaid spending by $103 million by excising dental, vision and hearing coverage, in addition to reducing the roll of people in the Basic Health program by half, by dropping childless adults. Similar cuts to dental, mental health and rehabilitation services are included in Gov. Davis’ plan.
In the meantime, advocates believe state legislators can do more to balance spending with additional sources of income, as “the governor’s budget contains no new revenues for state government,” says Liu. “Before considering cuts in services to California’s most vulnerable populations — families living in or near poverty, the elderly, and the disabled — the state needs to also consider revenue increases.”
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