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Dangerous Times for Medicaid

Published online by Cambridge University Press:  01 January 2021

John V. Jacobi
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Extract

These are indeed dangerous times. In the name of “cost-effectiveness,” we cut back health benefits to the poor, who are more likely to be sick than the nonpoor. We miss our chance to heal. In the setting, we’re told, of “scarce resources,” we imperil the health care safety net. In the name of expedience, we miss our chance to be humane and compassionate.’

Medicaid is again - still - the subject of reform discussions in Washington and in state capitals. The program has been subject to varying, sometimes conflicting pressures since its inception. Its primary purpose has been serving the health care needs of the poor and disabled. It was structured, however, to appeal to (or at least to not alienate) private health care providers. In addition, its mix of state and federal funding and control was intended to draw in the states as partners.

Type
Independent
Information
Journal of Law, Medicine & Ethics , Volume 33 , Issue 4 , Winter 2005 , pp. 834 - 843
Copyright
Copyright © American Society of Law, Medicine and Ethics 2005

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References

Farmer, P., Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: University of California Press, 2005): 176.Google Scholar
See Stevens, R. and Stevens, R., Welfare Medicine in America: A Case Study of Medicaid (New York: The Free Press, 1974): 80–81.Google Scholar
See Furrow, B. R. et al, 2d ed., Health Law (St. Paul, MN: West Publishing, 2000): 587–90. The best source for timely data on the Medicaid program is the Kaiser Family Foundation web site on Medicaid and the Uninsured. See <http://www.kff.org/medicaid/index.cfm> (last visited November 1, 2005).Google Scholar
See Iglehart, J. K., “The Dilemma of Medicaid,” New England Journal of Medicine 348, no. 21 (2003): 2140–2148.CrossRefGoogle Scholar
See Pediatric Specialty Care, Inc. v. Arkansas Dep't of Human Services, 364 F. 3d 925 (8th Cir. 2004); Rosie D. v. Swift, 310 F. 3d 230 (1st Cir. 2002); Atrican v. Odom, 290 F. 3d 178 (4th cir. 2002); Health Care for All, Inc. v. Romney, 2005 WL 1660677 (D. Mass 2005).Google Scholar
See Perez-Pena, R., “Trying to Get, and Keep, Care Under Medicaid,” New York Times, October 18, 2005, p. B1; Ross, D. C. and Cox, L., Beneath the Surface: Barriers Threaten to Slow Progress on Expanding Health Coverage of Children and Families (Kaiser Commission on Medicaid and the Uninsured, October, 2004).Google Scholar
Editorial, “The Shameless 20,” St. Louis Post-Dispatch, March 27, 2005; Wadhwani, A., “TennCare Cuts Kick in, but not Safety Net,” Tennessean, August 21, 2005.Google Scholar
See Sanchez v. Johnson, 416 F. 3d 1051, 1060 (9th Cir. 2005).Google Scholar
See Smith, V. et al, The Continuing Medicaid Budget Challenge: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2004 and 2005: Results from a 50-State Survey (Kaiser Commission on Medicaid and the Uninsured, October, 2004); Iglehart, , supra note 4, at 2141–2142.Google Scholar
See Coghlin, T. A., Zuckerman, S., “Three Years of State Fiscal Struggles: How Did Medicaid and SCHIP Fare?” Health Affairs Web Exclusive, W5–385 (August 16, 2005), available at <http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.385v1> (last visited November 1, 2005).CrossRef+(last+visited+November+1,+2005).>Google Scholar
See National Governors Association: Short Run Medicaid Reforms (August 29, 2005), available at <http://www.aapddc.org/News/commission/MedicaidReform.pdf> (last visited November 1, 2005); National Conference of State Legislatures: NCSL Resolution Adopted by the Task Force on Medicaid from the Fall Forum of the NCSL Standing Committees (December 2004), available at <http://www.ncsl.org/statefed/medicaidactionpolicy1204.htm> (last visited November 1, 2005).+(last+visited+November+1,+2005);+National+Conference+of+State+Legislatures:+NCSL+Resolution+Adopted+by+the+Task+Force+on+Medicaid+from+the+Fall+Forum+of+the+NCSL+Standing+Committees+(December+2004),+available+at++(last+visited+November+1,+2005).>Google Scholar
The Medicaid Commission Report (September 1, 2005), available at <http://www.cms.hhs.gov/faca/mc/090105rpt.pdf> (last visited November 1, 2005). The September 1, 2005 report concerns the five-year recommendations; the Commission is scheduled to submit its long-term report by December 31, 2005. Id. at 7.+(last+visited+November+1,+2005).+The+September+1,+2005+report+concerns+the+five-year+recommendations;+the+Commission+is+scheduled+to+submit+its+long-term+report+by+December+31,+2005.+Id.+at+7.>Google Scholar
See Hulse, C., “House Republicans Put Off Vote on Cuts,” New York Times, October 20, 2005, p. A 18.Google Scholar
See CMS, “State Waiver Programs and Demonstrations,” available at <http://www.cms.hhs.gov/medicaid/waivers/waivermap.asp> (last visited November 1, 2005); Kaiser Commission on Medicaid and the Uninsured, State Specific Section 1115 Waiver Fact Sheets <http://www.kff.org/medicaid/waivers-index.cfm> (last visited November 1, 2005).+(last+visited+November+1,+2005);+Kaiser+Commission+on+Medicaid+and+the+Uninsured,+State+Specific+Section+1115+Waiver+Fact+Sheets++(last+visited+November+1,+2005).>Google Scholar
See Pear, R., “U.S. Gives Florida a Sweeping Right to Curb Medicaid,” New York Times, October 20, 2005, p. A1.Google Scholar
Medicaid Commission Report, supra at 7.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra at 1.Google Scholar
See Pear, R., “Congress Weighs Big Cuts to Medicaid and Medicare,” New York Times, October 30, 2005, at 22.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra at 3.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 19, at 3–4; Medicaid Commission Report, supra note 7, at 9–10.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 19, at 3–4; Medicaid Commission Report, supra note 7, at 10.Google Scholar
Medicaid Commission Report, supra note 7, at 10–11.Google Scholar
See Pear, R., supra note 18.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 19, at 4; Medicaid Commission Report, supra note 7, at 12.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 19, at 4; Medicaid Commission Report, supra note 7, at 11.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 19, at 5.Google Scholar
National Governors Association: Short Run Medicaid Reforms, supra note 11, at 5.Google Scholar
Pear, R., supra note 18, at 22 (quoting Representative Nathan Deal, Republican of Georgia).Google Scholar
See “The 2005 HHS Poverty Guidelines,” available at <http://aspe.hhs.gov/poverty/05poverty.shtml> (last visited November 1, 2005).+(last+visited+November+1,+2005).>Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 19, at 5.Google Scholar
See Medicaid Commission Report, supra note 7, at 12.Google Scholar
See National Governors Association: Short Run Medicaid Reforms, supra note 11, at 5.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 19, at 6.Google Scholar
Id. at 6–7.Google Scholar
42 C.F.R. 440.230(b).Google Scholar
See Florida Agency for Healthcare Administration, Application for 1115 Research and Demonstration Waiver, August 30, 2005, available at <http://ahca.myflorida.com/Medicaid/medicaid_reform/waiver/pdfs/medicaid_reform_waiver_final_101905.pdf> (last visited November 1, 2005). See also CMS, Special Terms and Conditions (for approval of Florida waiver), available at <http://ahca.myflorida.com/Medicaid/medicaid_reform/waiver/pdfs/cms_special_terms_and_conditions.pdf> (last visited November 1, 2005).+(last+visited+November+1,+2005).+See+also+CMS,+Special+Terms+and+Conditions+(for+approval+of+Florida+waiver),+available+at++(last+visited+November+1,+2005).>Google Scholar
See Congressional Budget Office, Budget Options – Health, July 27, 2005, pp. 17–18, available at <http://www.cms.hhs.gov/faca/mc/summary_of_options081705.pdf> (last visited November 1, 2005); “Bush Administration Gives Congress Policy Language for Medicaid Reforms,” BNA Health Law Reporter, August 18, 2005, p. 1107.+(last+visited+November+1,+2005);+“Bush+Administration+Gives+Congress+Policy+Language+for+Medicaid+Reforms,”+BNA+Health+Law+Reporter,+August+18,+2005,+p.+1107.>Google Scholar
See Congressional Budget Office, supra note 37, at 15–16.Google Scholar
Congressional Budget Office, supra note 37, at 15.Google Scholar
See Rosenbaum, S., “Medicaid,” New England Journal of Medicine 346, no. 8 (2002): 635–640; National Governors Association, Medicaid Reform: A Preliminary Report 2 (June 15, 2005) available at <http://www.nga.org/Files/pdf/0506medicaid.pdf> (last visited November 1, 2005).CrossRefGoogle Scholar
See Rosenbaum, , id. at 636.Google Scholar
See Rosenblatt, R. E., “Health Care Reform and Administrative Law: A Structural Approach,” Yale Law Journal 88 (1978): 243–336, at 289, quoting HEW, Handbook of Public Assistance Administration, Supplement D, Medical Assistance Program § 5140.CrossRefGoogle Scholar
Id. at 292.Google Scholar
See Stevenson, R. W., “The Nation: The High Stakes Politics of Spending the Surplus,” New York Times, January 7, 2001, Section 4, p. 3; Shaviro, D. N., “Reckless Disregard: The Bush Administration's Policy of Cutting Taxes in the Face of an Enormous Fiscal Gap,” Boston College Law Review 45 (2004): 1285.Google Scholar
See Rosenbaum, , supra note 40, at 635; Kaiser Commission on Medicaid and the Uninsured, “The Medicaid Program at a Glance,” (January 2005), available at <http://www.kff.org/medicaid/upload/The-Medicaid-Program-at-a-Glance-Fact-Sheet.pdf;> Rowland, D., “Medicaid – Implications for the Health Safety Net,” New England Journal of Medicine 353, no. 14 (2005): 1439–1441.Google Scholar
Kaiser Commission on Medicaid and the Uninsured, Medicaid Budgets, Spending and Policy Initiatives in State Fiscal Years 2005 and 2006: Results from a 50-State Survey 9 (October 2005), available at <http://www.kff.org/medicaid/upload/Medicaid-Budgets-Spending-and-Policy-Initiatives-in-State-Fiscal-Years-2005-and-2006-report.pdf> (last visited November 1, 2005).+(last+visited+November+1,+2005).>Google Scholar
See Rosenbaum, , supra note 40, at 637.Google Scholar
See Holahan, J. and Ghosh, A., “Understanding The Recent Growth in Medicaid Spending, 2000–2003,” Health Affairs, Web Exclusive (January 26, 2005) W5–52–W5–62, available at <http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.52v1> (last visited November 1, 2005).CrossRef+(last+visited+November+1,+2005).>Google Scholar
See Trubeck, L. G., “The Health Care Puzzle: Creating Coverage for Low-Wage Workers and Their Families,” in Handler, J. F. and White, L., eds., Hard Labor (New York: M. E. Sharpe, 1999).Google Scholar
Cooper, P. F. and Schone, B. S., “More Offers, Fewer Takers for Employment-Based Health Insurance,” Health Affairs (November-December, 1997): at 145.Google Scholar
See Glied, S. A. and Borzoi, P. C., “The Current State of Employment-Based Health Coverage,” Journal of Law, Medicine & Ethics 32 (2004): 404–409; Hoffman, C. et al, “Holes in the Health Insurance System – Who Lacks Coverage and Why?” Journal of Law, Medicine & Ethics 32 (2004): 390–396.CrossRefGoogle Scholar
See Gabel, J. et al, “Health Benefits in 2005: Premium Increases Slow Down, Coverage Continues to Erode,” Health Affairs 24, no. 5 (2005): 1273–1280; Anderson, G. F. et al, “It's the Prices, Stupid: Why the United States is so Different from Other Countries,” Health Affairs 22, no. 3 (2003): 89-105.CrossRefGoogle Scholar
See Greenhouse, S. and Barbara, M., “Wal-Mart Memo Suggests Ways to Cut Employee Benefit Costs,” New York Times, October 26, 2005, p. A1 (citing internal Wal-Mart document embracing strategies for shrugging off benefits costs; internal document available at <http://www.nytimes.com/packages/pdf/business/26walmart.pdf> (last visited November 1, 2005).+(last+visited+November+1,+2005).>Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 40, at 1.Google Scholar
See Holahan and Ghosh, supra note 48.Google Scholar
See Pediatric Specialty Care, Inc. v. Arkansas Dep't of Human Services, 364 F. 3d 925 (8th Cir. 2004); Rosie D. v. Swift, 310 F. 3d 230 (1st Cir. 2002); Atrican v. Odom, 290 F. 3d 178 (4th cir. 2002); Health Care for All, Inc. v. Romney, 2005 WL 1660677 (D. Mass 2005).Google Scholar
See Kaiser Commission on Medicaid and the Uninsured, The Continuing Medicaid Budget Challenge: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2004–2005 (October 2004), at 9; Kaiser Commission on Medicaid and the Uninsured, Medicaid Enrollment and Spending by “Mandatory” and “Optional” Eligibility and Benefit Categories, (June 2005).Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 40, at 11–13.Google Scholar
See Pear, R., supra note at 18 (quoting Representative Nathan Deal, Republican of Georgia).Google Scholar
See Wright, B. J. et al, “The Impact of Increased Cost Sharing On Medicaid Enrollees,” Health Affairs 24, no. 4 (2005): 1106–1116; Newhouse, J. P., Pricing the Priceless: A Health Care Conundrum (Cambridge: The MIT Press, 2002): 16-17.CrossRefGoogle Scholar
See Wright, B. J. et al, supra at 1112–1113.Google Scholar
See National Governors Association, Medicaid Reform: A Preliminary Report, supra note 40, at 6–7.Google Scholar
See Editorial, “The Shameless 20,” St. Louis Post-Dispatch, March 27, 2005; Wadhwani, A., “TennCare Cuts Kick in, but not Safety Net,” Tennessean, August 21, 2005; Smith, V. et al, The Continuing Medicaid Budget Challenge: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2004 and 2005: Results from a 50-State Survey (Kaiser Commission on Medicaid and the Uninsured, October 2004); Coghlin, T. A., Zuckerman, S., “Three Years of State Fiscal Struggles: How Did Medicaid And SCHIP Fare?” Health Affairs, Web Exclusive, W5–385 (August 16, 2005), available at <http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.385v1> (last visited November 1, 2005).Google Scholar
Jacobi, J. V., “Consumer-Directed Care and the Chronically Ill,” University of Michigan Journal of Law Reform 38, no. 3 (2005): 531–585.Google Scholar
See Robinson, J. C., “The End of Managed Care,” Journal of the American Medical Society 285 (2001): 2622.Google Scholar
See Jost, T. Stoltzfus, Disentitlement? The Threats Facing Our Public Health-Care Programs and a Rights-Based Response (New York: Oxford University Press, 2003): 127–129.Google Scholar
Id.Google Scholar
See Robinson, J. C., supra note 65, at 2623.Google Scholar
See Siegel, B. et al, “Health Reform and the Safety Net: Big Opportunities; Major Risks,” Journal of Law, Medicine & Ethics 32, no. 3 (2004), 426–432.CrossRefGoogle Scholar
See Jost, T. Stoltzfus, supra note 66 at 128.Google Scholar