Too simple to work

July 11, 2006

Rep. Charlie Norwood, whose congressional service is shaped by his years as a Georgia dentist, came up with what seemed a simple and fair way to make sure his low-income constituents weren't getting squeezed out of Medicaid by immigrants falsely claiming American citizenship.

Make 'em prove it, he said. Force states to end a practice that allows applicants for Medicaid benefits to identify themselves as citizens by checking a box on a form. Formal documentation, such as birth certificates or passports and photo IDs, will henceforth be required, thanks to the Norwood proposal approved by Congress this year.

As federal and state officials scrambled over the past month to comply with this seemingly simple enforcement tool, though, they have confronted a bureaucratic nightmare that threatens to cut off benefits to precisely those low-income Americans Mr. Norwood says he's out to help. More troubling for the long term is the prospect of denying access to routine and preventive medical care, properly or not, to yet another group of people who will thus be forced to turn for care to overburdened hospital emergency rooms.

No one knows how big the fraud problem is. The Congressional Budget Office has estimated that 35,000 people out of 50 million would be dropped from Medicaid rolls over 10 years by the Norwood rule, but that is just an educated guess.

What we do know is that kicking such folks off Medicaid won't solve any budget problems for the states. As Maryland Health Secretary S. Anthony McCann observed: "They still have a need for health care."

Ideally, a new focus on the low-income uninsured will provide the impetus to expand the network of public health clinics. But that costs money, too - probably more than what might be saved by Medicaid.

For now, Maryland officials and their counterparts across the nation are moving slowly to implement the Norwood rule because it imposes such difficulty for those who can't find official papers. What's more, there are logistical problems. For example, the Baltimore agency that processes about 3,000 Medicaid applications a month from pregnant women with children now works mostly by mail. If clients all have to come to the East Baltimore office in person, they will find one receptionist, two chairs and no parking.

Federal officials are also trying to be flexible, allowing alternative forms of documentation and witness affidavits. About 150,00 elderly and disabled Marylanders have been exempted entirely. Mr. Norwood is willing to make legislative fixes if necessary to make sure no citizen is harmed.

After all this effort, though, it seems doubtful anything useful will be achieved. Mr. Norwood might well score points with anti-immigrant voters. But instead of making the Medicaid system fairer, his proposal seems likely to further expose the gross inadequacy of the entire health care system.

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