LITTLE ROCK — Fifteen million low-income adults, including more than 200,000 Arkansans, would become eligible for Medicaid under a provision of the Senate health-care bill being debated in Washington.
But it’s one of many issues that has the Senate divided as Democratic leaders arrive this week at their hoped-for deadline for passing the legislation.
The Patient Protection and Affordable Care Act would expand eligibility to adults who make up to 133 percent of the federal poverty level. That would be $14,404 annually for an individual, or$29,327 annually for a family of four, according to current poverty guidelines.
It would be a uniform, nationwide requirement in a program in which eligibility rules can vary greatly from state to state.
Proponents say the expansion would reduce the number of people without health insurance, while providing federal money to cover the bulk of the cost for states.
But opponents say many Medicaid enrollees already have trouble finding doctors willing to accept them, and an expansion would only worsen the problem at a higher cost to the federal government.
Medicaid is the government health program paid for jointly with federal and state funds. Arkansas’ Medicaid program covers different groups, including children of low-income families, foster children and people with disabilities.
Though Arkansas’ program does cover some parents of Medicaid-enrolled children, the program generally covers low-income adults only if they are disabled, pregnant or have certain cancers, said Julie Munsell, spokesman for the Arkansas Department of Human Services. About 700,000 of Arkansas’ 2.9 million residents are enrolled in the program.
The Medicaid expansion is just one part of the more-than-2,000-page bill that Senate Democratic leaders are pushing to pass by Christmas..
If it’s ultimately approved, states could expand their rolls as early as 2011. The federal government would cover the full cost for the expanded population from 2014 to 2016, and 95 percent of the cost for the next two years, according to the office of U.S. Sen. Blanche Lincoln, D-Ark.
U.S. Sen. Mark Pryor, DArk., said it would be a “big change” for Arkansas.
“This one change right here would provide health-care coverage for about 225,000 Arkansans,” he said. “This is a way to get a lot more people to have insurance and to try to get those uninsured numbers down.”
But some Republicans warn that an expansion would do more harm than good.
In a statement on the Senate floor last month, U.S. Sen. Lamar Alexander, R-Tenn., likened it to confining adults who would qualify to a “medical ghetto.”
The Congressional Budget Office estimates the expansion would add 15 million Americans to the Medicaid rolls, making it the largest single expansion in the program’s history, Alexander said.
“Expanding Medicaid to cover uninsured individuals is a terrible vehicle for health-care reform, because dumping this many more people into that program will increase problems for beneficiaries getting access to care and for maintaining quality,” he said. “Plus the program is already riddled with fraud and abuse; this would invite more of that.”
A FAMILY’S STORY
Cory Crane of Maumelle plans to appeal the state’s decision to deny him Medicaid coverage. He’s confined to a wheelchair after a Nov. 7 motorcycle accident, and said he can’t afford to cover medical bills that have grown to $65,000.
A former Nevada police, fire and emergency medical services officer, Crane said he hasn’t followed the health-care debate closely, but doesn’t understandwhy he can’t get Medicaid. He was told he’d only qualify if he made $700 a month, or was divorced or unemployed.
“I feel like I’m being punished because I’m doing the right thing, because I’m working and because I’m making my marriage work,” said Crane, national secretary for the American Coppers Motorcycle Club for retired and active-duty police officers.
Crane was driving to volunteer at Harmony Health Clinic - a free medical and dental clinic in Little Rock - when the back brakes of his motorcycle locked up on an interstate exit ramp. He was able to steer the bike into a grass median, but broke his right leg and shattered his right humerus - the large bone in the upper arm.
He spent four days in the hospital, where surgeons operated on his arm and put ametal plate in his right knee. The doctor wanted to send him to a rehabilitation facility, but Crane insisted his family could provide the care he needed at home.
His home is at Hi-Boy Mini Storage in Maumelle, where Crane works as the property manager. The job provides a two-bedroom apartment built above some of the storage units, which he shares with Misty, his wife of 12 years, and their two sons, Nicholas, 4, and Steven, 11.
Unable to get upstairs in his wheelchair, Crane has made the facility’s office his temporary living quarters. A donated hospital bed is pushed into one corner, and his eldest son sleeps on a folding cot in case he needs help.
A 5 1/2-foot Christmas tree stands on the other side of the room, lovingly decorated by hissons to brighten up the room.
“We even picked Nicholas up to let him put the star on the tree,” Steven said.
The star is made of pine cones, matching ones that serve as ornaments, collected from Misty’s family home in Tyler, Texas.
“I did it perfecto,” Nicholas said of placing the star. “That’s the most beautiful star Mom had ever seen.”
Crane said he’s grateful to have a boss who allows him to stay in the office and continue working as he recovers. But because of his injuries, he’s had to close his own locksmith business, which he worked in the evenings after the storage facility closed. That cut the family’s income by more than half to about $11,000 a year, making covering even their regular bills difficult.
The boys are covered by ARKids First, the state’s Medicaid program for children of low-income families. But Crane said he and his wife can’t afford the $300 to $400 a month it would cost them for private insurance.
So for now, they’re relying on the generosity of friends and acquaintances who have donated things such as medical equipment and food. Asked how Christmas will be this year for the family, Crane just shakes his head and sighs.
“I don’t know,” Crane said. “It’s been tough.”
HIDDEN COSTS
Roy Jeffus, director of Arkansas Medicaid, said at a Dec. 10 Medicaid conference hosted by the Arkansas Foundation for Medical Care that an expansion would bring as many as 270,000 Arkansans into the Medicaid program. In addition to those who would be eligible under the new income requirements, it would also attract people who are eligible now, but don’t know it.
“Part of the thinking is that people that may not have been interested in signing up for Medicaid in the past would sign up,” he said.
Kathleen Stoll is deputy executive director and director of health policy at Families USA, a national nonprofit, nonpartisangroup that says it’s “dedicated to the achievement of highquality, affordable health care for all Americans.” The group has come out in support of the proposed Senate bill.
In a teleconference Wednesday, Stoll said the proposed Medicaid expansion would “even out” Medicaid requirements nationwide.
“Right now eligibility levels vary tremendously in the different states, and in many states if you aren’t an adult with dependents, you’re not eligible for Medicaid at all,” she said.
Lincoln said in a statement Friday that too many Arkansans rely on the emergency room as their primary source of medical care because they don’t qualify for Medicaid and make too little to afford private health insurance.
Meanwhile, families that have health insurance end up paying for the cost of that care in the form of higher healthinsurance premiums estimated at as much as $1,500 a year, Lincoln said.
“And with health-care premiums growing almost six times faster than wages in the last decade, Arkansans will see more and more of their paychecks depleted without the passage of comprehensive health-care reform,” she said.
In a statement Sunday, Lincoln said the revised healthcare bill would expand access to 400,000 uninsured Arkansans. Her statement did not specifically mention Medicaid.
But Sen. John Cornyn, RTexas, wrote in a Dec. 15 column in The Dallas Morning News that the Medicaid expansion would only increase the burden on people who have insurance.
“Medicaid currently reimburses providers at very low rates, which is why 38 percent of doctors in the Dallas area won’t see Medicaid patients,” Cornyn wrote. “Those who do accept Medicaid make up the difference by charging more to those with private insurance. The Senate bill would increase this cost-shifting by forcing an additional 15 million Americans into Medicaid.”
Front Section, Pages 1 on 12/21/2009