Recommendations include removing the kidney disease program, charging co-pays for emergency room visits, reducing reimbursement for durable medical equipment, and placing limits on outpatient hospital visits. Every one of these proposals reduces or denies services to the patients Medicaid is supposed to protect. Eliminating the kidney disease program alone would leave patients stranded without care. The cut is particularly troubling for African-Americans, who are four times more likely than the general population to develop kidney disease, according to the National Kidney Disease Education program. Many of these patients will be forced to skip (or quit) medications and services if the program is cut. Here's the rub: Medicaid will still become responsible for providing care for these patients; it will just be later in the disease process, when they are critically ill and in need of far more complex and costly medical care.