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Bush to stress preventive care on visit to Baltimore tomorrow


WASHINGTON -- As part of a broader effort this week to highlight his domestic agenda, President Bush will visit a Baltimore program tomorrow that emphasizes preventive health care services for poor people.

Mr. Bush is scheduled to tour the East Baltimore Medical Center run by John Hopkins Hospital tomorrow afternoon and to address a group of business leaders later at nearby Dunbar High School. He will be promoting legislation that would make it easier for states to require patients whose health care is financed by Medicaid to enroll in similar programs.

With health care expected to be a significant issue in his re-election campaign, the president has embraced a controversial approach that attempts to restrain the exploding costs of medical care for the poor by changing the current system, which reimburses doctors on a fee-for-service basis.

Mr. Bush argues that that system encourages doctors to collect fees for unnecessary and expensive medical procedures that taxpayers have to finance. And he says it doesn't ensure that patients have someone monitoring their overall health needs to help them avoid serious illnesses.

But opponents of the change worry that forcing Medicaid patients into privately managed care systems, such as Mr. Bush is proposing, will make them vulnerable to unscrupulous operators who accept the fees and then scrimp on services.

"Managed care . . . ought to be an option for Medicaid patients to chose from, but it should not be the only option," said Rep. Henry A. Waxman, a California Democrat who chairs the health and environment subcommittee. "I've seen some managed-care programs that were awful."

In the Baltimore program, about 36,000 Medicaid recipients are enrolled in a health plan run by the Prudential Insurance Co. with medical services provided by Johns Hopkins Hospital.

In return for a fixed fee paid by Medicaid, these patients are offered a comprehensive array of services at the same level of care as 89,000 other members of the plan whose premiums are paid by their private employers. Doctors, dentists and nurses are supposed to work together to consider each patient's total needs. Such programs are often called health maintenance organizations, or HMOs.

Heavy emphasis is put on preventive care with special incentives forpregnant women to come in for pre-natal care, help with substance abuse problems and classes in parenting, according to Alixe Reed Glen, a spokeswoman for the health department. Mr. Bush is expected to drop in on more or more of these health care sessions during his visit, she said.

Maryland is one of many states that have turned to such programs as a way of controlling Medicaid expenses, which are only partly financed by the federal government.

Last year, Maryland was granted a waiver from a federal law that insists Medicaid patients must have a free choice of doctors and can't be forced into HMOs. Other states have won similar exceptions.

But the waiver process can be costly and time-consuming. Mr. Bush is supporting legislation that would make membership in a health care plan the rule for Medicaid patients rather than the exception. States would have to get a waiver to pay doctors on a one-visit-at-a-time basis as most do now.

No action on the legislation is expected this year because the health care issue has become caught up in the political gridlock between the Republican White House and the Democratically controlled Congress that may be broken only by the election.

As an alternative to forcing Medicaid recipients into health care programs, Mr. Waxman suggested the level of Medicaid reimbursements be raised to make sure that reputable health care providers will want to accept those patients.

Maryland has already taken the step of raising Medicaid fees on its own, according to Richard H. Wade, a spokesman for the American Hospital Association.

And while his organization supports the mandatory approach adopted in Maryland, Mr. Wade warned that no one should expect speedy results either in a dramatic reduction of Medicaid costs or a significant improvement in the health of the patients.

"It has enormous potential," he said. "But those looking for short-term results are going to be disappointed."

In a related health announcement, Mr. Bush said yesterday that the Department of Health and Human Services would begin running a series of advertisements in 15 cities, including Baltimore, urging mothers to get prenatal care and immunizations for their young children.

The ad campaign, part of a previously announced program called Healthy Start, follows Mr. Bush's theme of cutting medical costs by taking steps to keep people healthy.

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