MEDICAID: BOREN AMENDMENT REPEALED IN BUDGET DEAL

      The federal law that sets minimum reimbursement rates for
 what states pay hospitals and nursing homes, known as the Boren
 Amendment, would be repealed under the balanced budget deal
 expected to receive congressional approval today, NPR's Siegel
 reports.  The measure "has been a sore point among governors,"
 who have fought for repeal of the law "ever since it was
 enacted."  Gov. Mike Leavitt (R-UT) said that the law "limits
 states' abilities to get the best deals from providers."  He
 said, "What the states would like to do is say to a number of
 providers, 'Tell us what it is that you can provide this service
 for and compete on the basis of your quality and your price and
 we'll choose on the basis of competition'" ("All Things
 Considered," 5/20).  
      WINNERS & LOSERS:  Gov. Pete Wilson (R-CA) said of the
 proposed repeal, "We see this as a victory for California and all
 the other states" (Green, COPLEY NEWS SERVICE/San Diego UNION
 TRIBUNE, 5/20).  However, "[h]ealth care providers argue that
 repealing the law would allow states to reduce their payments. 
 And, they say, that would affect the availability and the quality
 of care that patients receive," according to NPR.  Medicaid
 providers contend "payment rates are already low, and if the
 Boren Amendment is repealed, nothing would prevent states from
 reducing the rates even further."  Jim Bentley, of the American
 Hospital Association, said rate reductions "could affect the
 quality of care given to patients, even their access to care,"
 with "many urban and rural hospitals" being the most adversely
 affected.  Bentley said, "What we will have is increasing
 hospital deficits.  And, because hospitals with high Medicaid
 populations also often have high uncompensated care patient
 loads, the most vulnerable hospitals financially ... will be the
 ones most at risk."  
      NOT SO FAST:  NPR's Que reports that Clinton administration
 officials "argue states are unlikely to let this happen."  Health
 Care Financing Administration Administrator Bruce Vladeck said
 "states have a strong interest in seeing that hospitals and
 nursing homes stay open."  He said, "They serve all the citizens
 in their community, not just those that are on Medicaid.  They
 are also often important employers in important communities. 
 States are not exactly cavalier about those issues."  And, even
 without the Boren Amendment, Vladeck said "there are still plenty
 of other laws that will enable the government to ensure the
 quality of the Medicaid program and patients' access to it."  Que
 reports that Vladeck said "there is another good reason to
 repeal" the Boren Amendment.  "Over the years, hospitals and
 nursing homes have used the law to challenge payment rates in
 court.  That has led to a rash of lawsuits that have cost the
 states even more," according to Que ("All Things Considered,"
 5/20).  Gov. Wilson said that in California alone, the repeal
 could save the state "hundreds of millions of dollars"
 (COPLEY/UNION TRIBUNE, 5/20).