Governors Ask for Medicaid Package To Aid Hurricane Evacuees; Grassley Threatens Budget Process
After testimony from the governors of Alabama, Louisiana and Mississippi -- the states hardest hit by Hurricane Katrina -- on Wednesday at a Senate Finance Committee hearing, some lawmakers pushed President Bush to "drop [his] opposition" to legislation that would alter Medicaid rules for hurricane survivors, the Washington Post reports (Weisman, Washington Post, 9/29).
The bill (S 1716), by Senate Finance Committee Chair Chuck Grassley (R-Iowa) and ranking member Sen. Max Baucus (D-Mont.), would have the federal government for five months pay 100% of Medicaid costs for survivors from Louisiana, Mississippi and parts of Alabama who have relocated to other states, with the option of extending the coverage for an additional five months. Under the $8.7 billion proposal, the federal government also would pay 100% of Medicaid costs through the end of 2006 for all beneficiaries in Louisiana, Mississippi and counties in Alabama that have been designated as disaster areas (California Healthline, 9/28).
The bill also would expand Medicaid eligibility from traditional categories -- such as women and children -- to include poor, childless men. In addition, the bill would create an $800 million fund for health care providers treating poor survivors, the Post reports.
The Bush administration has "balked at expanding" Medicaid, saying that hurricane survivors' health needs can be addressed through use of waivers, the Post reports (Washington Post, 9/29). HHS spokesperson Christina Pearson said that the state-by-state waiver process favored by the Bush administration "is a very good approach to meet [hurricane survivors'] needs immediately."
She said HHS has reached agreements with Alabama, Florida, Mississippi and Texas and is working out an agreement with Louisiana. The White House has said that one reason it believes the legislation is unnecessary is that the government has already created a temporary fund available to health care providers who treat uninsured storm survivors.
Grassley and Baucus have questioned whether the fund is large enough, as well as its legality, according to the AP/San Francisco Chronicle. Baucus on Wednesday attempted to bring the bill up for a vote, but Sen. Tom Coburn (R-Okla.) objected. Grassley said four or five senators have been blocking action on the bill (Freking, AP/San Francisco Chronicle, 9/28).
At the hearing, Louisiana Gov. Kathleen Blanco (D), who supports the Grassley-Baucus bill, said, "We've got people who have needs today, people who would never have imagined themselves needing Medicaid" (Shane, New York Times, 9/29). Twenty percent of evacuees from Louisiana who have applied for Medicaid benefits have been determined to be ineligible before they finished filling out their applications, and one-third of evacuees who completed the application were denied coverage, according to the Louisiana Department of Health and Hospitals (Washington Post, 9/29).
Blanco said 41% of businesses in Louisiana have been destroyed or forced to close (Curtius, Los Angeles Times, 9/29). Alabama Gov. Bob Riley (R), while saying that any changes made to Medicaid in the aftermath of the hurricane should not be made permanent, noted that the "only way" to address the health care needs of hurricane survivors is to enact legislation (Washington Post, 9/29).
Mississippi Gov. Haley Barbour (R), who last week strongly endorsed the Grassley-Baucus bill, said he now supports having the federal government pay 100% of Medicaid costs for the afflicted region but opposes provisions in the bill that would expand eligibility (Rovner/Heil, CongressDaily, 9/28). The AP/Chronicle reports that the National Governors Association has praised the bill, saying, "You have been willing to work with us in making sure that the needs of our most vulnerable citizens are addressed" (AP/San Francisco Chronicle, 9/29).
Grassley, reacting to recent criticism about the bill from HHS Secretary Mike Leavitt, said, "I would suggest that people at the White House need to know that the chances of our getting a reconciliation bill moving out of my committee are very difficult if we don't get [the Medicaid bill] behind us." The fiscal year 2006 budget reconciliation process calls for $35 billion in spending reductions, and the Senate Finance Committee has been charged with securing $10 billion in cuts from Medicaid over five years.
Grassley's comment "elicited gasps from the packed hearing room," as Grassley is "usually one of the administration's staunched supporters, and he had already urged senators to quickly move the spending bill," the Los Angeles Times reports. An unnamed senior Senate aide said that if Grassley does not allow his portion of the spending bill out of committee, it "would severely weaken the reconciliation process" (Los Angeles Times, 9/29).
"Senators from both parties vowed to fight for the [Medicaid] legislation," the New York Times reports. Sen. Trent Lott (R-Miss.) said, "We can work with everybody, including the [Bush] administration, or against them, and I'm prepared to go either way" (New York Times, 9/29). While Grassley expressed optimism that concern from conservatives about expanding an entitlement program could be eased, Baucus said, "Based on conversations I've had, their bottom line is so far down it's virtually non-negotiable" (CongressDaily, 9/28).
Speaking to Blanco, Baucus said, "There are senators who already say, 'Well, that's too much.' We've appropriated $62 billion, basically, in disaster assistance. Much of that's wasted." Baucus added, "That's one of the main reasons why we're having a hard time getting this Medicaid bill passed, frankly." Sen. John Sununu (R-N.H.), who has urged greater caution in Katrina-related expenditures, said, "We need to do much more to try to find ways to cover this additional spending so we do not increase the deficit and leave an unfortunate financial legacy for future generations" (Los Angeles Times, 9/29).