Unhealthy cuts

The Baltimore Sun

It's hard to imagine a worse time to cut billions in federal Medicaid spending, but that's what the Bush administration is doing. The program provides bedrock medical care for the poorest Americans, who are already feeling the most pain from an economy in the doldrums, as well as the soaring costs of gasoline and food. A bipartisan, veto-proof majority in the House has already passed legislation delaying imposition of the cuts for a year. The Senate should do the same.

White House officials say new rules restricting future Medicaid spending on rehabilitation, outpatient care, transportation and graduate education are necessary to close loopholes used by states to "inappropriately enhance their claimed medical expenditures." State officials say any loopholes could have been closed without using what they call a sledgehammer approach. Lets face it: The Bush administration is using the changes in a backdoor effort to contain the mounting costs of providing basic medical care for the poor.

Maryland and other states are already struggling to pay their share of Medicaid costs in the face of falling tax revenues. This state would lose an estimated $65 million a year in Medicaid funding under the new rules, officials estimate. Nationally, about $13 billion in Medicaid spending would be saved over five years, federal officials say. But the states put the cost at closer to $50 billion. In Baltimore, funding for a program aimed at lowering the infant mortality rate and promoting the healthy development of babies with home visits to new mothers would suffer sharp cuts under the administration's new rules. Similar outreach programs elsewhere in the state would also suffer.

Although the House voted 349-62 to delay the rules, President Bush has threatened to veto that legislation, and Republican leaders in the Senate are siding with him. In these hard times, the number of very poor Americans eligible for Medicaid coverage is expected to grow significantly. While the increasing cost of Medicaid looms beside Social Security as a dangerous drain on the national treasury, managing that challenge requires a more thoughtful and comprehensive approach. Finding answers should be an early priority of the next administration.

Meanwhile, it would be penny wise and pound foolish to cut healthy-baby programs and outpatient and rehabilitation services. Shortchanging care in those areas could lead to costly medical emergencies that taxpayers will end up paying for.

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