Judy Waxman

(WOMENSENEWS)–Bush administration plans to cut as much as $60 billion from the Medicaid program over the next decade would put millions of American women at risk of losing vital healthcare services, say women’s health activists.

The Medicaid cuts were part of the 2006 Federal Budget, unveiled by President George W. Bush on Monday. The Medicaid cutbacks are the largest single reduction to any government program in the new budget, which also contains proposals for $15 billion in new spending for programs aimed mostly at children.

Although details of the planned cutbacks were vague, targeted programs include nursing home care, lowering prices the government pays for prescription drugs and giving the states more flexibility in determining eligibility and services. Women might be required to buy health insurance from their employers if it’s offered, no matter what their income.

Medicaid is designed to cover low-income individuals and families. Eligibility requirements and coverage differ from state to state, but women are twice as likely as men to qualify for Medicaid.

The planned cutbacks would put women, who make up over 70 percent of adult Medicaid recipients, most at risk. One in ten American women, 16 million in total, receive their health coverage through Medicaid. Medicaid provides them with vital health care services, including basic health care, reproductive health services, mental health services, on-going care for chronic conditions and disabilities and nursing home care.

Women’s health activists had spent months lobbying against any major changes to Medicaid. The National Women’s Law Center predicted the cutbacks would have a devastating impact on women. “With health insurance coverage declining, especially among women, this country cannot afford to cut the program that provides essential health care to women, children and low-income elderly Americans,” the organization’s co-president Marcia D. Greenberger, said.

Women at Risk

A study, published in 2004 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, reported that women receiving Medicaid are more likely than the total population to be of reproductive age, poor, minorities, less educated and parents. Over a third of low-income women receive health coverage through Medicaid. For most of these women, Medicaid is their only option for health care.

Medicaid pays the costs for two out of three of all nursing home residents, most of them the most frail, elderly and disabled. The majority (over 71 percent) are women. These women must be poor or face catastrophic medical costs to qualify. Close to 70 percent of all Medicaid recipients are either elderly or disabled and cost for their care is the biggest chunk of the Medicaid program–almost 7 times higher than annual costs for services for women and children.

Under the Bush budget proposals, titled, “Supporting a Compassionate Society,” these patients would be moved out of nursing homes to a home-based community care program, which would shift major responsibility to the states. The plan is not detailed in the budget, which also calls for making long-term care insurance available to the elderly.

Gary Karr, a spokesperson for the Department of Health and Human Services, the government agency responsible for Medicaid, defended the cuts. “The savings the administration is proposing do not cut any programs, so the administration believes they will not have any impact on recipients. What the President is seeking to do is give states the ability to cover people who need care the most.”

Women’s health advocates argue the plan is unrealistic and unworkable.

“To begin with, we’re talking about moving current residents, most of them no longer have homes to go back to,” Dr. Laurie Young, executive director of the Older Women’s League, a Washington based advocacy group, said. “The majority of the frail elderly are still going to need institutional care.”

“As for long term care insurance, that is beyond the means of most women,” Young added. “My fear is that if these proposals go through many older women will fall through the cracks.”

Giving State Programs Greater Flexibility

The most troubling proposal in the Bush budget, many advocates say, is the plan to give states more flexibility to decide who and what they can cover. Advocates say this flexibility means there may no longer be guaranteed coverage for current recipients. Medicaid is an entitlement program; anyone who meets eligibility requirements may enroll. The states and the federal government share in funding Medicaid services, with the federal government providing the majority of the funding.

Early on, the Bush administration suggested changing Medicaid to a block grant or capped program, where the states receive a predetermined amount of money.

Advocates have fought against block grants or caps, because they would limit funding and services and reduce the number of people who could qualify for Medicaid. Although the Bush budget never mentions the words block grants, the proposed changes contain all of the elements of a spending cap program. The proposed plan shifts not only more decision making to the states, but a greater financial burden on them as well, since states would be left to pay increased costs.

Even now, without block grants or caps, as the states faced substantial budget problems of their own, all of them have implemented measures to reduce Medicaid costs. They have set new eligibility requirements, restricted or reduced benefits and imposed higher co-payments for beneficiaries.

Under the new proposals advocates fear the states will be forced to make additional cutbacks, even in programs now designated as mandatory. “I assume that everything is up for grabs,” Judy Waxman, vice president, Health and Reproductive Rights at the National Women’s Law Center, said. She pointed out that Bush has said that mandatory family planning services should be optional, although this is not detailed in the budget.

“When you couple them saying that they will let the states do whatever they want to do as long as they don’t spend any more money, it’s clear that it is going to reverberate in serious cuts to the Medicaid program. I think it is almost certain that there will be cuts in long-term care, cuts in drugs,” Waxman said.

She pointed out that Secretary of Health and Human Services Michael Leavitt, in office for less than a month, was one of the first governors to take away both mandatory and optional programs, including some hospital care, when he was governor of Utah.

She is also disturbed at a proposal that would require people to buy employer-based health plans, even if they can’t afford it. “This would affect many low income women,” she added.

The government claims that the cuts are necessary to reduce the deficit. But while the budget cuts social programs, it extends the 2001-2003 tax cuts at a cost of over $1 trillion over the next ten years.

The House and Senate Budget Committees will now draft their own spending plans, which will need to be passed by Congress. Over the next month, women’s groups and healthcare advocates say they will continue their efforts to preserve Medicaid as a safety net for low-income women.

Ann Pappert is a Brooklyn-based journalist who has covered women’s health for many years. Her pieces have appeared in newspapers and magazines in the U.S. and Canada as well as NBC and ABC and the Canadian Broadcasting Corporation.

For more information:

Kaiser Family Foundation: Kaiser Commission on Medicaid and the Uninsured: