Struggling states cut healthcare for poorThe unprecedented reductions come as millions are losing their jobs and insurance. They are so steep that the federal rescue package may not be able to revive them.By Noam N. Levey
January 14, 2009
Reporting from Washington — Even as President-elect Barack Obama plans an ambitious push to expand health coverage nationwide, states are slashing health services to their poorest residents amid the economic downturn.
The unprecedented cuts in public assistance come as millions of Americans are losing their jobs and health insurance.
In many cases, the cuts are so deep that even the massive federal rescue package being assembled on Capitol Hill may not be enough to restore services being eliminated in the burgeoning crisis, health officials warn.
And the faltering economy has all but killed trailblazing state campaigns to expand coverage for the working poor -- once seen as hopeful signs for national healthcare reform.
Illinois' senior citizens are facing the traumatic prospect of being moved from nursing homes teetering on the edge of bankruptcy as the homes wait for months to be paid by the floundering state government.
South Carolina has cut treatment for low-income women under 40 with breast or cervical cancer and stopped providing nutritional supplements for people with kidney failure.
In southern Nevada, cancer patients without health coverage no longer have a place to get chemotherapy after the state's largest public hospital stopped providing outpatient oncology services.
"This is exactly the time when we should be beefing up services," said Anthony Wright, executive director of Health Access California, a leading consumer advocacy group. "Instead, we are unraveling the safety net to the point where it may not be possible to stitch it back together again."
The Democratic-controlled U.S. House of Representatives began offering some help today, approving a measure to extend federally funded heath insurance to 4 million more children.
The legislation, which is expected to be signed into law by Obama, would commit about $33 billion over the next 4½ years to the popular State Children's Health Insurance Program.
The 12-year-old program now covers about 7 million children from families just above the poverty line that earn too much to qualify for Medicaid.
Lawmakers on Capitol Hill are also at work on a stimulus package that could include as much as $100 billion to bail out Medicaid, the primary federally funded health program for the poor administered by the states.
That aid package is expected to require states to maintain some of the medical services currently on the chopping block, though it may come too late to reverse many cuts already made.
Lawmakers plan additional assistance to help Americans keep their health insurance if they lose their jobs.
But even some congressional leaders concede the help will be insufficient. "Let's be honest," said Sen. Richard J. Durbin (D-Ill.), a close Obama ally. "We won't be able to save every soul here."
At least 44 states are facing budget shortfalls over the next two years totaling more than $350 billion, according to a recent survey by the Center for Budget and Policy Priorities, a liberal Washington-based think tank.
In the last recession -- which was mild compared with what many economists say is happening now -- more than 1 million people lost health coverage as 34 states cut eligibility for public health programs, the center found.
Unable to run deficits like the federal government, states have been scrambling for months to cut aid to schools, universities and, increasingly, residents who rely on the state for medical care.
Nationwide, roughly 60 million low-income people -- half of them children -- use the Medicaid program to get some form of healthcare, including basic physician services, prescription drugs, X-rays, dental care and even hospice care.
Some of those services are now in jeopardy.
California Gov. Arnold Schwarzenegger, who is wrestling with about $40 billion in shortfalls a year after his plan for universal healthcare coverage collapsed, has proposed ending free medical care or cutting services for millions of Californians, some in families making as little as $14,000 a year.
Policymakers also are considering cuts in grants to low-income elderly, blind and disabled Californians, many of whom rely on the checks to pay for home-based services so they can avoid institutionalization.
Florida is poised to cut its home services for poor senior citizens, such as bathing and meal preparation, as nearly 19,000 seniors in the state are on a waiting list to get the care rather than be sent to nursing homes.
Utah lawmakers are looking at cutting public health programs and eliminating coverage for about 20,000 low-income people who rely on the state-funded Utah Primary Care Network.
"The scale of this is unprecedented," said AARP Vice President Elaine Ryan, who has spent nearly three decades working on health policy at the state and federal level. "I really have never seen anything like this."
Some states have tried to avoid cuts in services by delaying or reducing payments to doctors and other medical providers who treat low-income patients.
This is taking a toll, however, as a growing number of providers stop treating those with state-funded insurance.
Nevada's largest county closed its outpatient oncology clinic last year, citing decreases in Medicaid funding for treating low-income cancer patients.
Now, advocates in Las Vegas are having to counsel patients to look at getting care by moving to other states where they have relatives.
"We're essentially creating medical refugees," said Stacey Gross, community programs manager at Susan G. Komen for the Cure of Southern Nevada.
Melvin Siegel, who operates five nursing homes serving some 400 seniors around Springfield, Ill., said he is close to closing because of slow payments from the state.
Nursing homes, which rely heavily on Medicaid, often don't have the option of rejecting patients on public assistance.
"There is no place to go," said Siegel, 79, who said he has borrowed against his home, life insurance and retirement savings to keep in business. "If this falls apart, I'll be penniless. . . . It's never been this bad."