'They are taking away his opportunity to live,' man's wife says
In Illinois, a pharmacist closes his business because of late Medicaid payments. In Arizona, a young father's liver transplant is canceled because Medicaid suddenly won't pay for it. In California, dentists pull teeth that could be saved because Medicaid doesn't pay for root canals.
Francisco Felix and his wife Flor Fleix talk in their Laveen, Ariz., home about how his liver transplant was canceled because Medicaid suddenly would not pay for it. Across the country, state lawmakers have taken harsh actions to rein in the budget-busting costs of the health care program that serves 58 million poor and disabled Americans. Some states have cut payments to doctors, paid bills late and trimmed benefits such as insulin pumps, obesity surgery and hospice care.
Lawmakers are bracing for more work when they reconvene in January. Some states face multibillion-dollar deficits. Federal stimulus money for Medicaid is soon to evaporate. And Medicaid enrollment has never been higher because of job losses.
In the view of some lawmakers, Medicaid has become a monster, and it's eating the budget. In Illinois, Medicaid sucks up more money than elementary, secondary and higher education combined.
"Medicaid is such a large, complicated part of our budget problem, that to get our hands around it is very difficult. It's that big. It's that bad," said Illinois Sen. Dale Righter, a Republican and co-chairman of a bipartisan panel to reform Medicaid in Illinois, where nearly 30 percent of total spending goes to the program.
In the Arizona case, lawmakers have stopped paying for some kinds of transplants, including livers for people with hepatitis C. When the cuts took effect Oct. 1, Francisco Felix, 32, who needs a liver, suddenly had to raise $500,000 to get a transplant.
His case took a dramatic turn in November when a friend's wife died, and her liver became available. Felix was prepped for surgery in hopes donations would come in.
When the money didn't materialize, the liver went to someone else, and Felix went home. His doctor told him he has a year before he'll be too sick for a transplant.
"They are taking away his opportunity to live," said his wife, Flor. "It's impossible for us or any family to get that much money."
Medicaid costs are shared by the federal and state governments. It's not just the poor and disabled who benefit. Wealthier people do, too, such as when middle-class families with elderly parents in nursing homes are relieved of financial pressure after Medicaid starts picking up the bills.
Contrary to stereotype, it's the elderly and disabled who cost nearly 70 cents of every Medicaid dollar, not the single mother and her children.
California's Medicaid won't pay for many adult dental services. But it still pays for extractions. Therefore, dentists pull teeth that could be saved.
The choices are difficult for states that have already cut payments to doctors and hospitals to the bone.
"If we don't see an economic recovery where state revenues rebound, they're really going to be very strained on how they can make ends meet," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured.
--
By Carla K. Johnso, The Associated Press