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PWAs could be the losers in budget battle

The debate around the GOP plan to balance the budget in seven years devolved into an exchange of barbs during the recent impasse that led to a shutdown of the federal government. Were one simply to read the headlines -- "Gingrich numbers down," "Clinton tees while government closes doors" -- one would think that only the loss of political ground in the eyes of the media and the American electorate, were at stake. Lost in the debate was the fact that many of the budget components the GOP leadership maintain are essential to "getting America back on track," would in fact help finance what are clearly misplaced budget priorities -- tax cuts, increased military spending and corporate welfare left intact.

Meanwhile, the beleaguered Medicaid program hangs in the balance. Hanging in the balance, too, are the lives of more than 36 million poor and medically needy Americans, including about half of all Americans living with AIDS, who would suffer needlessly under any plan to block grant Medicaid to the states with no meaningful guidelines -- thus allowing the states more control over the program --while providing drastically smaller amounts of federal dollars with which to care for people.

Some in the AIDS community consider the Ryan White CARE Act the "single most important program" for people living with HIV disease. In fact, while the Ryan White CARE Act provides more than $630 million annually for the care of people with AIDS, more than $3 billion each year in federal Medicaid dollars goes for medical services to the poorest and sickest of people with AIDS. The Ryan White CARE Act was created to respond to gaps in many states' Medicaid-based health care service infrastructures, and to offer critical enabling and social services not funded through the Medicaid program. The Ryan White CARE Act program, which is itself a federal program vulnerable to cuts under a 7-year balanced budget plan, was never intended to serve as the primary source of health care services for Americans living with HIV disease. Thus, with last year's failed effort to enact national health care reform with universal coverage, the Medicaid program is the last, ultimate safety net for people living with HIV disease.

As obviously important as this program is to people with AIDS and the one in ten Americans now on Medicaid, the final Congressional budget bill, passed largely along party-line votes on November 17, would repeal the current Medicaid program and replace it with a "Medigrant" program to the states with very few minimum federal requirements. Medigrant also makes drastic cuts in projected Medicaid spending over the next seven years -- anywhere from the Congressional Budget Office (CBO) estimate of $163 billion in federal funds, to a staggering $420 billion cut in total federal and state Medicaid contributions as predicted by the Washington-based Center on Budget and Policy Priorities (CBPP). This level of cuts, the CBPP says, assumes that the states would provide just enough funding to receive their full federal block grant allocations, but would not voluntarily provide state-only Medigrant funds on top of that -- a very real possibility in a radically reformed program shorn of federal requirements. Additionally,although the Medigrant bill requires states to provide some level of coverage to pregnant women, children under age 13, and some disabled individuals (the states have complete discretion in defining "disabled individuals" for the purposes of this feeble protection), the bill guarantees to no one any minimum benefits package.

There are viable, practical alternatives that are much less painful than the radical surgery the GOP leadership is intent on performing on Medicaid. The Clinton administration and key Democratic members of Congress have proposed establishing a cap on the growth of spending per beneficiary, called a "per capita" cap, instead of a rigid block grant formula. A per capita cap would allow states to receive a fixed amount of federal dollars per beneficiary. A different cap, or limit, would be established for each major category of beneficiaries, including pregnant women, children, disabled individuals, and the elderly. A per capita cap would allow for continued growth in the number of Medicaid beneficiaries and would maintain the current eligibility criteria and benefits package. By capping the rate of increase in the amount that a state can spend on each beneficiary, this plan would also reduce federal Medicaid spending, but the cuts would not be as drastic, and changes would not be as disruptive. It should be made clear, however, that cutting $54 to $85 billion out of the Medicaid program by instituting a per capita cap is in itself not an acceptable way to control health care spending -- legislating universal health care coverage with cost containment is. But in the current political climate, a per capita cap on federal Medicaid spending may be the most viable alternative to a Medicaid block grant.

Let there be no mistake about it. This budget debate is not about politics as usual, but about profound decisions about the role of the national government in taking care of its own citizenry. In the eleventh hour, the nation is rightly questioning the fine print scrawled somewhere in the Republican leadership's blueprint for balancing the budget in seven years. What Americans are discovering is that the centerpiece of the GOP leadership's government overhaul plan -- a balanced budget -- will be financed not by "savings" but instead by heartless, avoidable cuts to programs of vital importance to this country's most vulnerable citizens. Americans are coming to the realization that this slashing of vitally important social programs could indeed affect them, their families, and their loved ones. Public opinion has turned against the Republican leadership's balanced budget plan. In particular, Americans understand the importance of preserving the integrity of the Medicaid program and its time-honored guarantee of access to basic health care to women, children, frail elderly and disabled individuals, including people living with HIV/AIDS.

No one can deny that harnessing the spiralling cost of health care in this country is necessary -- it was necessary last year when the Congress lacked the political will and prudence to enact universal health care reform and it is necessary today. But the effort to balance the federal budget cannot deprive vulnerable people of their health care and must have a strong commitment to maintaining fundamental standards of fairness and compassion. Basic health care coverage for low-income women, children, the elderly and disabled individuals -- the guarantee Medicaid has offered Americans for more than 30 years -- embody those standards and therefore must be preserved.

For more information, contact
Joe Zuniga
AIDS Action Council
1875 Connecticut Avenue NW #700
Washington DC 20009
202-986-1300 x 3042
202-986-1345 (fax)
202-332-9614 (tty)
E-Mail: HN3384@handsnet.org

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12/4/95--HandsNet Public Forums--HN3384