Health Care Bills Would Expand Medicaid Eligibility

ROBERT SIEGEL, host: We’re going to hear more now about the state of Medicaid from Mary Agnes Carey, who’s a reporter for Kaiser Health News, which has been helping us to produce this series about people and their health care.

Welcome to the program.

Ms. MARY AGNES CAREY (Reporter, Kaiser Health News): It’s great to be here.

(Reporter, Kaiser Health News): It’s great to be here.

SIEGEL: And we should note at the outset that Kaiser Health News is not affiliated with Kaiser Permanente, the insurance company.

Let’s start with what’s being proposed in Congress. What would change about Medicaid that seems to have made a number of governors anxious about how it’s going to affect them? What do the bills in Congress actually say?

Ms. CAREY: Both the House and the Senate proposals, as they now are drafted, would expand Medicaid eligibility to about 133 percent of the federal poverty level. For an individual, that’s about $14,000 and it’s about $29,300 for a family of four. And they would also help the states cover the cost.

The governors are very worried that the additional federal money simply won’t be enough. They’ve got state budget deficits that could be as high as $200 billion next year. They’re worried about the pressure already from the increased Medicaid enrollees on their budgets. And they’re also worried about something called the woodworking effect, that people who are currently – could apply for Medicaid haven’t done so. There’ll be more information about Medicaid and increased eligibility and they will come out, which will create further pressure on the system. So, those are some of the things they are concerned about.

SIEGEL: Today, it’s figured that there are almost 60 million Americans on Medicaid. And presumably, if eligibility is loosened, there’d be more.

Ms. CAREY: Right. They’re estimating about 11 million new Medicaid beneficiaries out of this.

SIEGEL: It’s a shared program between the states and the federal government. And you say the bills in Congress would help the states pay for the added Medicaid burden, but they wouldn’t pay for all of it.

Ms. CAREY: No, it wouldn’t pay for all for it. Now, we have to see what the final bills look like. But in the House bill it was changed in one of the committees where the federal government would pick up 100 percent of the cost for about two years and then they would ask state governments to pick up about 10 percent.

The Senate Finance Committee approved a bill last week that would help the states cover between 77 to 95 percent of the cost, depending on the state, how many of these new beneficiaries they currently enroll in that sort of requirement. So it would depend on what they’re currently doing. But they do want to help them cover some of those costs.

SIEGEL: Now, in Jeff Brady’s story, the Medicaid enrollee whom we heard about was Gracie Scarrow, a woman in her 90s. First of all, would eligibility be altered for seniors like her?

Ms. CAREY: No. That eligibility would stay the same. This is for the non-elderly population. That’s where that 133 percent of the poverty level would be expanded for coverage.

SIEGEL: So, put us in the view here of a governor of his state, who obviously, like everyone in the country, is having rough economic times. And you’re seeing a reform come at you that would increase eligibility for not the elderly, but for younger patients to Medicaid. How would you pay for it?

Ms. CAREY: Well, they can’t cut the benefits. That’s against the law. But they could reduce payments to their providers. They’re also worried about this influx of new Medicaid beneficiaries. The concern is in many states, Medicaid doesn’t – pays below Medicare, pays far below the private market.

SIEGEL: You’re saying that a doctor who might be paid $100 for a visit that’s insured by a private insurer might be paid a good deal less than that under Medicare and still less than that under Medicaid.

Ms. CAREY: That’s right. And so the concern is if you expand Medicaid enrollment, those providers who may already feel squeezed will be squeezed further. There’s also a concern for several – for many Medicaid beneficiaries. There’s problems with access to care, especially access to specialty care because of the low reimbursement. And if you put more people into the program, they’re concerned that those problems could worsen.

SIEGEL: Is access to specialty care, I mean, to translate this, does that mean a lot of specialists just won’t do it? They won’t work for that money if the Medicaid patient comes to them?

Ms. CAREY: That happens in many cases. And so what has to happen is a physician who’s treating that Medicaid patient may have to call a friend of theirs who’s a specialist in a particular area and ask them to take that Medicaid patient.

SIEGEL: When people talk about the cost of Medicaid to the federal government and to the states, generally, how expensive is this whole program?

Ms. CAREY: For fiscal year 2007, it was about $330 billion for state and federal spending combined. This new Medicaid expansion would cost an additional $44 billion a year or about $438 billion over the next decade.

SIEGEL: Mary Agnes Carey, thanks a lot for talking with us.

Ms. CAREY: Glad to be here.

SIEGEL: Mary Agnes Carey is with Kaiser Health News. Our series, Are You Covered, is produced in partnership with Kaiser Health News, which is a nonprofit news service.