Budget Resolution Passes the House with Medicaid Cuts

URGENT ACTION NEEDED!!!

Senators Arlen Specter (R-PA) and Tom Harkin (D-IA) are expected to offer an amendment to the Budget Resolution to restore cuts in the health domestic discretionary programs. These programs include the Ryan White CARE Act, Prevention, Research, and Housing.

Call your Senators and tell them to vote YES on the Specter-Harkin amendment to the Budget Resolution. The Senate is expected to complete work on Budget Resolution tomorrow, Thursday, May 22. CONTACT YOUR SENATORS NOW. Call the senate switchboard at (202) 224-3121 and asked to be connected to your Senator's office.

**This is the first of two alerts on the budget process. This report focuses on the Medicaid program. Later this week, we will send out a bulletin on the appropriations process. **

Budget Resolution and Medicaid

The House of Representatives passed a Budget Resolution (BR) last night which includes $13.6 billion in Medicaid cuts over 5 years. The BR, based on the budget agreement between the Congressional Republican leadership and the Clinton Administration, is expected to pass the Senate by a large margin on Thursday, May 22. The budget agreement identified funding targets for cuts with some detail on how the cuts may be achieved. Through the BR, the House and the Senate will instruct the authorizing and appropriating committees on how much savings they will need to identify, but not exactly how to achieve these savings. The funding levels included in the budget resolution are binding, but the authorizing and appropriations committees will have some significant latitude in determining how to fund specific programs and how to cut or modify others.

No legislation has been developed yet to map out the details of budget cuts to programs like Medicaid and Medicare. Because they are entitlement programs, the only way to get savings out of the program is to change the way the program works through legislation. The Health Subcommittee of the Commerce Committee, which has jurisdiction over Medicaid, Medicare Part B and the new children's health initiative included in the BR, will begin to "mark up" legislation, making changes to these programs on June 4. The full Commerce Committee will consider the proposals soon thereafter. The final legislation on Medicaid and Medicare will be included in a Budget Reconciliation bill which may be completed by the July 4 recess.

Medicaid Cuts

Although legislation has not yet been introduced laying out the details of the $13.6 billion in cuts to the Medicaid program, we have some ideas how the cuts may be achieved. We are concerned that however the cuts are achieved, they will have a negative impact on health care access for people living with HIV/AIDS and other vulnerable populations.

A significant portion of the Medicaid cuts will most likely come from cuts to the Disproportionate Share Hospital (DSH) program, which assist hospitals that provide large volumes of care to uninsured and Medicaid populations. Some states have abused the DSH program by identifying hospitals as DSH hospitals even if they do not provide care to high volumes of people within these populations. Despite the abuses in the program, DSH funding has provided crucial support to hospitals, many of which provide safety-net care for people living with HIV/AIDS. We are advocating targeting DSH cuts in a manner that will protect those hospitals that provide high levels of care, including uncompensated care, to low income and Medicaid populations. Across-the-board DSH cuts will allow further abuses in the program and undermine the ability of public hospitals to provide care to uninsured individuals, undocumented persons and Medicaid clients with HIV/AIDS.

Other State Flexibility Options

In addition to the cuts in the DSH program, other state flexibility proposals are being considered as additional sources of Medicaid cost savings. These flexibility proposals would compromise access and quality of care under Medicaid. Some of these proposals would:

1. Allow Medicaid managed care plans to charge co-payments that would be too costly to individuals who require frequent usage of services and drugs like people living with HIV/AIDS.
2. Require individuals who are dually eligible for Medicaid and Medicare to enroll in managed care programs. Currently, these individuals have the option, but are not required to enroll in managed care plans. The majority of people with HIV/AIDS on the Medicare program are also eligible for Medicaid.
3. Eliminate cost-based reimbursement for federally qualified health centers and rural health clinics. These community health centers provide lots of AIDS care. They have been historically reimbursed for the cost of the services they provide because of the complicated health care needs of the low income individuals and families they serve.
   

AIDS Action

If your representative is a member of the House Commerce Committee (see attached list), tell them:

• Target DSH cuts so that hospitals that provide care to uninsured people with HIV/AIDS and Medicaid patients continue to have the resources to deliver quality care.
• No flexibility to governors on Medicaid co-payments. Co-payments are barriers to care for people with many health care needs, like people with HIV/AIDS
• No payment reductions to federally qualified health centers. They provide vital health care services to people living with HIV/AIDS .
• Do include strong managed care quality protections in the Medicaid bill.
  

If your representatives are not members of the Commerce Committee, tell them to take these messages below to their Commerce Committee colleagues.

105th Congress
HOUSE COMMERCE COMMITTEE
2125 Rayburn House Office Building,
Washington, DC 20515-6115
(202) 225-2927

Name/Staff/Phone/Fax:

Thomas J. Bliley, Jr. (R-VA)(Chairman)/Brent Del Monte/225-2815/225-0011

W.J. (Billy) Tauzin (D-LA)/Michelle Prejean/225-4031/225-0563

Michael G. Oxley (R-OH)/Scott Meyer/225-2676/No fax listed

Michael Bilirakis (R-FL)(Health & Environment Subcommittee Chairman)/Patty DeLoatche/225-5755/225-4085

Dan Schaefer (R-CO)/Patrick O'Keefe/225-7882/225-7885

Joe L. Barton (R-TX)/Beth Hall/225-2002/225-3052

Dennis Hastert (R-IL)/Bitzi Bavin/225-2976/225-0697

Fred Upton (R-MI)/Jeff Meyers/225-3761/225-4986

Cliff Stearns (R-FL)/Veronica Crow/225-5744/225-3973

Bill Paxon (R-NY)/Jacklyn Hawks/225-5265/225-5910

Paul E. Gillmor (R-OH)/Bill Wilson/225-6405/225-1985

Scott Klug (R-WI)/Wendy Dean/225-2906/225-6942

James Greenwood (R-PA)/Suzanne Cobbs/225-4276/225-9511

Michael D. Crapo (R-ID)/Ms. Lee Hathaway/225-5531/225-8216

Christopher Cox (R-CA)/Peter Uhlmann/225-5611/225-9177

Nathan Deal (R-GA)/Jennifer Rich-Health+Janel Guerrero-Housing/225-5211/225-8272

Richard Burr (R-NC)/Betsy Haywood/225-2071/225-2995

Brian Bilbray (R-CA)/Jennifer Stephens/225-2040/225-2948

Edward Whitfield (R-KY)/Tim Taylor/225-3115/225-3547

Greg Ganske (R-IA)/Jon Traub/225-4426/225-3193

Charlie Norwood (R-GA)/Chris Koppen/225-4101/225-3397

Rick White (R-WA)/Gretchen Lamberg/225-6311/225-3524

Tom Coburn (R-OK)/Roland Foster/225-2701/225-3038

Steve Largent (R-OK)/Marie Wheat/225-2211/225-9187

Rick Lazio (R-NY)/no staff listed/225-3335/225-4669

Barbara Cubin (R-WY)/Bryan Jacobs-Health+Rob Miller-Housing/225-2311/225-3057

**James Rogan (R-CA)/Windy Lynagh-Health+Ann Mooney-Housing/225-4176/225-5828

**John Skimkus (R-IL)/Steve Madden-Housing+Cheryl Crate-Health/225-5271/225-5880

John D. Dingell (D-MI)(Ranking Minority Member)/* Kay Holcolmbe+Richard Heald/226-3400+225-4071/225-5288+225-7727

Henry Waxman (D-CA)(Health & Environment Subcommittee)(Ranking Minority Member)/Karen Nelson/225-3976/225-4099

Edward J. Markey (D-MA)/Karen Bates/225-2836/no fax listed

Ralph Hall (D-TX)/Grace Warren/225-6673/225-3332

Bill Richardson (D-NM)/Kathy Keith-Health+/Donda Morgan-Housing/225-6190/no fax listed

John Bryant (D-TX)/Abby Hochberg/225-2231/225-0327

Rick Boucher (D-VA)/Laura Hanen/225-3861/225-0442

Thomas J. Manton (D-NY)/Elizabeth O'Hara/225-3965/225-1909

Edolphus Towns (D-NY)/Alex Beckles/225-5936/225-1018

Sherrod Brown (D-OH)/Kevin Brennan/225-3401/225-2266

Bart Gordon (D-TN)/Robin Moll/225-4231/225-6887

Elizabeth Furse (D-OR)/Christopher Porter/225-0855/225-9497

Peter Deutsch (D-FL)/Libby Mullin/225-7931/225-8456

Bobby L. Rush (D-IL)/Bryan Byers/225-4372/226-0333

Anna G. Eshoo (D-CA)/Bill Bates/225-8104/225-8890

Ron Klink (D-PA)/John George/225-2565/226-2274

Bart Stupak (D-MI)/Diane Coplin/225-4735/225-4744

Tom Sawyer (D-OH)/Heather Stephens-Health+Derrick Owens-Housing/225-5231/225-5278

Al Wynn (D-MD)/no staff listed/225-8699/225-8714

Gene Green (D-TX)/Mike Hollon/225-1688/225-9903

Karen McCarthy (D-MO)/Scott DeFife/225-4535/225-4403

**Ted Strickland (D-OH)/Annelise Hafer/225-5705/225-5907

**Diana DeGette (D-CO)/no staff listed//225-4431/225-5657

* committee staff
** new member as of January 10, 1997

For more information, contact:

1875 Connecticut Avenue NW
Suite 700
Washington DC 20009
202-986-1300
202-986-1345 (fax)
202-332-9614 (tty)
E-Mail: aidsaction@aidsaction.org