3 senators assail GOP's reform plan for Medicaid Lawmakers from Md., Wash. fear burden for middle class


WASHINGTON -- Continuing Democratic efforts to generate opposition to Republican Medicaid legislation, Maryland's senators warned yesterday that the GOP proposal is a threat to middle-class families who have a parent or spouse in a nursing home.

"I never believed I would see America turn in this cruel, mean, brutish direction," Sen. Paul S. Sarbanes told a news conference, attributing the provisions in the bill to a GOP "mania for a $250 billion tax cut."

LTC Mike Collins, a spokesman for the House committee that wrote )) the Medicaid legislation, responded by saying, "What they are trying to do is throw scare tactics at the American people."

Although Medicaid is a federal-state health care plan for the poor, it also pays nursing home costs for the middle-class elderly who have exhausted most of their assets.

The House and Senate are considering legislation to turn Medicaid over to the states, end the federal guarantee that anyone who qualifies can collect benefits and trim projected spending by $182 billion over seven years.

Mr. Sarbanes, at a Capitol Hill news conference with Sens. Barbara A. Mikulski of Maryland and Patty Murray of Washington, said the House GOP legislation would end the 1988 "spousal impoverishment" exemption written by Ms. Mikulski. The senators said the law allows the elderly to keep some assets while getting Medicaid coverage for a spouse's nursing home care.

The House GOP legislation would allow states to make adult children liable for the nursing home bills of their parents, they said. Federal laws now prevent 29 states, including Maryland, from enforcing their own statutes that make adult children responsible for the health care costs of their parents, they said.

Mr. Collins, spokesman for the Commerce Committee, responded that Republicans have been unable to verify that the 29 states have those laws. He said the Democrats' fear is unfounded and that, if necessary, the bill would be amended on the floor. "We will not let legislation pass that will allow that to happen," he added.

Rep. Ron Klink, a Pennsylvania Democrat, tried to get the GOP bill amended in committee to insulate adult children, but his proposal was rejected on a party-line vote. Mr. Collins said the GOP did not believe the amendment was necessary.

"The potential for this is scary," Mr. Klink insisted yesterday. A family could end up with four parents in nursing homes at a cost of $160,000 a year, he said.

According to the federal Health Care Financing Administration, Medicaid pays more than half of the nation's nursing home bills and covers 68 percent of nursing home patients.

Overall, Medicaid pays health care bills for 37 million Americans. The program cost $156.5 billion in the fiscal year that ended Sept. 30, with the federal government paying $89.2 billion.

The states have wide discretion in setting eligibility and benefit levels and the federal government pays its share, no matter what it costs. The Republican legislation would change that, giving each state a set amount of money and holding down the rate of growth.

The Medicaid legislation written by the Senate Finance Committee retains Ms. Mikulski's spousal protection and protects families from liability for their parents' medical care. But the House Commerce Committee rejected Democratic proposals to include the same protections in its bill.

Mr. Collins, the committee spokesman, responded that the bill had been changed in committee to require states to protect the assets of spouses of nursing home patients. He said states now have such protections -- with 36 having more generous standards than the federal standards.

Ms. Mikulski said she is concerned that the final bill -- which would be crafted in negotiations after the House and Senate adopt their own versions -- would drop the federal protections.

Earlier this week, she threatened to chain herself to her desk on the Senate floor over the issue.

"We will not yield," she said yesterday. "This is a bottom-line issue for Democrats."

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