[PEN-L:1693] Re: Cuts?

[Jim Westrich <westrich@xxxxxxx>]

At 10:22 AM 12/4/95 -0800, you wrote:
>Any thoughts about the claim that the GOP's Medicare plan(s) relies on
>decreases in projected expenditure increases rather than *real cuts*?
>Several of the Right's spokespersons claim that there are NO CUTS in the
>plan.  I'm somewhat skeptical of this claim.  What do you think?

[NO MEDICARE CONTENT FOLLOWS]

I have not followed Medicare changes as closely as Medicaid but the same
language is being used there.  The proposed Medicaid changes are simply to
block grant the program for each state and restrict growth.  Therefore, the
semantic claim of "no cuts" can be made. (I think there is some actual cuts
in the language of the legislation but they are minor--e.g., no more SSI
eligibility for substance abuse so 25,000 poor substance abusers will lose
coverage of their treatment). I have personally been using the semantic
construction "cuts in historical trends" others use "spending reductions"
and surprisingly many newspapers use "cuts".

Now it is obvious that the states will have to "cut" something but the true
beauty of the block grant is that Congress can claim they did not "cut"
anything.  All the painful and real choices have to made (and opposed) in
50+ places.  It is the very definition of divide and conquer (that is not to
say that in some states "good things" will not happen). For example, part of
the block grant restrictions are that 75% or so has to be spent on current
"mandatory services" which means that most of the cuts will of necessity be
in programs currently called "optional" [list available but just look in any
Medicaid reference book].  These programs include a whole host of programs
related to chronic care and people with disabilities will lose a lot of
services (I am working on a group report that will discuss the impact of
Medicaid cuts on people with developmental disabilities--if anyone is
interested in an electronic copy I should be able to provide you with one if
the demand is light).  People who get Medicaid witchdoctor coverage in
Louisiana will likely lose.  Women who get Medicaid midwife services will
likely lose.  The list goes on.

If anyone is interested in a blow by blow of what is to be cut in Medicaid
the best source is "Cutting Medicaid Spending In Response To Budget Caps",
Holahan, Coughlin, et al. which you can get by calling the Kaiser Commission
on the Future of Medicaid (1-800-656-4533).  I can summarize myself but why
not get it directly.




Jim Westrich
University of Illinois--Chicago
Institute on Disability and Human Development (M/C 626)
Applied Research Unit
1640 W. Roosevelt Rd.
Chicago, IL  60608
Phone: (312) 413-7862  Fax:  (312) 413-1326