Cruel and usual

April 29, 2003

IT COMES as little surprise that when money gets tight, those who have the least get squeezed the most.

Maryland and states all over the country, coping with shrinking tax revenues and growing expenses, are balancing their books at the expense of health care for the working poor.

State officials don't have much choice - Medicaid is where the money is. The joint federal-state medical insurance program for the poor, elderly and disabled is the fastest-growing piece of most state budgets and accounts for nearly one-fifth of their total expenditures.

Maryland legislators tried to minimize the impact by trimming $18 billion out of the program for next year without kicking anyone off the insurance rolls. Even so, families of four earning as little as $34,000 a year will have to start in July paying a $37 monthly premium for their health coverage.

Senate Democrats and moderate Republicans, fighting to halve President Bush's $726 billion tax cut, would direct some of the money instead to a $30 billion relief package for the states, about half of it earmarked to prevent Medicaid cuts. Maryland's share would be $467 million over 18 months.

Both the head and the heart argue for something like that. Society pays medical costs for the poor one way or the other. It's cheaper and kinder to provide regular access to care, preventive screenings and prescription drugs before ailments reach the point where they require hospitalization.

Surely, this is a better use of federal money than cutting taxes for the richest of the rich, as Mr. Bush proposes.

But the relief package is only intended as a short-term fix to get the states through the current lean times before the economy picks up and tax revenues grow.

Medicaid and Medicare - and perhaps the entire health care system - need a thorough overhaul to avoid a long-term crisis of much greater proportion as baby boomers age.

Medicaid costs are already approaching $1,000 for every man, woman and child in Maryland. Some of those paying for it through their taxes don't have health insurance themselves, or don't have benefits as generous as what Medicaid provides to the half-million Marylanders on its rolls.

Meanwhile, Maryland legislators blocked a $2 million proposal to curb Medicaid drug costs this year because they were pressured by the pharmaceutical lobby, which resists any attempt to rein in its profits. The same pressure has prevented lawmakers in Congress from adding a drug benefit to Medicare, which would greatly relieve the burden on Medicaid.

What's more, much of the program originally intended as a safety net for poor women and children now serves the middle-class elderly with long-term care. Medicaid pays nearly half of all nursing home expenses in this country, sometimes for people who have transferred their assets to relatives so they can meet the limits on wealth.

Gov. Robert L. Ehrlich Jr. serves on a bipartisan task force of governors trying to produce a Medicaid redesign for the long haul. If they succeed, they'll certainly have deserved whatever quickie federal help they can get in the meantime.

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