PI Action alerts & updates ... 1997

Pressure Needed to Keep Congress from Cutting Medicaid

Issue
Negotiations between the President and the Congress over a balanced budget agreement continue. It is possible that a deal could be struck in the next few days and it is also possible that they could fail to reach a deal at all. Cutting Medicaid is not necessary to balance the budget. The HIV community needs to weigh in forcefully at this time to let Congress know that cutting Medicaid would limit access to care for people living with HIV. Further cuts to Medicaid are unacceptable.

Project Inform opposes the President’s proposal to cut $22 billion from Medicaid (over the 1998-2002 fiscal year period) and his plan to institute per capita caps (per person spending limits that would limit the amount of federal dollars that state Medicaid programs could receive). The President has also proposed $13 billion in new Medicaid spending to help mitigate some of the harmful effects of the welfare reform legislation that he signed. We support these efforts , but they need not come at the expense of current Medicaid beneficiaries.

Some Republicans in Congress are countering the Presidents’ offer by proposing to accept the President’s $22 billion in cuts, but without his new spending proposals.

Background
Medicaid is the single most important program serving people living with HIV. Seven of the ten dollars spent on AIDS in America come from Medicaid. Medicaid provides health care to more than 90% of children living with HIV and roughly half of the adults with AIDS.

Cutting Medicaid is not necessary. The Congressional Budget Office (CBO) is widely recognized as the most unbiased source of financial projections for Medicaid. As of January 1997, CBO forecasts of future Medicaid spending have fallen to $618 billion by the 1998-2002 period. This is below Republican proposals in 1996 for $626 billion in Medicaid spending of the same period as part of their balanced budget proposal. It is also far below projected Medicaid spending in the President’s initial balanced budget proposal of December 1995.

Per capita caps will squeeze Medicaid AIDS care. People living with HIV comprise less than 1% of all Medicaid beneficiaries and their health care expenses make up only 2% of total Medicaid costs. Nonetheless, per capita caps which are based on paying state Medicaid programs on the basis of average costs from all people with disabilities would unfairly target people with AIDS and others with extensive health care needs. The average annual cost of care for a person with a disability on Medicaid is approximately $8,000. Without protease inhibitors and other new drugs, the average cost of care for a person with AIDS exceeds $20,000 in many locations. If states are reimbursed from the federal government on the basis of only the initial $8,000, then state Medicaid programs would seek ways to limit Medicaid eligibility for people with HIV/AIDS and they would seek ways to limit necessary health care services to people with HIV/AIDS in the program.

Action Needed:
Call or email your U.S. Representative and two U.S. Senators with the following message:

• Cutting Medicaid is not necessary.
• Per capita caps create unacceptable incentives to deny necessary care to people with HIV/AIDS.
• Per capita caps are irresponsible cost shifts. Per capita caps contain many of the same negative features that caused block grants to be decisively rejected in last year’s Medicaid debate. Per capita caps would exacerbate inequities among states, they would fall hardest on states that have not invested heavily in their Medicaid programs, and they have the potential to pit various groups of Medicaid beneficiaries against each other as the caps squeeze necessary health care.
• We can avoid efforts to enact per capita caps by not making further cuts to Medicaid.

It is especially important to contact the following members of the House and Senate Budget Committee, who will soon be debating this issue:

House Budget Committee: Republicans

John R. Kasich (chairman) Ohio 202.225.5355
David L. Hobson Ohio 202.225.4324
Christopher Shays Connecticut 202.225.5541
Wally Herger California 202.225.3076
Jim Bunning Kentucky 202.225.4706
Lamar Smith Texas 202.225.4236
Dan Miller Florida 202.225.5015
Bob Franks New Jersey 202.225.5361
Nick Smith Michigan 202.225.6276
Bob Inglis S. Carolina 202.225.6030
Susan Molinari New York 202.225.3371
Jim Nussle Iowa 202.225.2911
Peter Hoekstra Michigan 202.225.4401
John Shadegg Arizona 202.225.3361
George Radonovich California 202.225.4540
Charles F. Bass New Hampshire 202.225.5206
Mark W. Neumann Wisconsin 202.225.3031
Mike Parker Mississippi 202.225.5865
Robert L. Ehrlich, Jr. Maryland 202.225.3061
Gil Gutknecht Minnesota 202.225.2472
Van Hilleary Tennessee 202.225.6831
Kay Granger Texas 202.225.5071
John E. Sununu New Hampshire 202.225.5456
Joseph R. Pits Pennsylvania 202.225.2411

House Budget Committee: Democrats

John M. Spratt, Jr. (Ranking Minority Member) S. Carolina 202.225.5501
Jim McDermott Washington 202.225.3106
Alan B. Mollohan West Virginia 202.225.4172
Jerry F. Costello Illinois 202.225.5661
Patsy T. Mink Hawaii 202.225.4906
Earl Pomeroy North Dakota 202.225.2611
Lynn C. Woolsey California 202.225.5161
Lucille Roybal-Allard California 202.225.1766
Lynn Rivers Michigan 202.225.6261
Lloyd Doggett Texas 202.225.4865
Bennie G. Thompson Mississippi 202.225.5876
Benjamin L. Cardin Maryland 202.225.4016
David Minge Minnesota 202.225.2331
Scotty Baesler Kentucky 202.225.4706
Ken Bentsen Texas 202.225.7508
Jim Davis Florida 202.225.3376
Brad Sherman California 202.225.5911
Robert A Weygand Rhode Island 202.225.2735
Eva Clayton N. Carolina 202.225.3101

Senate Budget Committee

Pete V. Domenici (chairman) New Mexico 202.224.6621
Charles E. Grassley Iowa 202.224.3744
Don Nickles Oklahoma 202.224.5754
Phil Gramm Texas 202.224.2934
Christopher (Kit) Bond Missouri 202.224.5721
Slade Gorton Washington 202.224.3441
Judd Gregg New Hampshire 202.224.3324
Olympia J. Snowe Maine 202.224.5611
Spencer Abraham Michigan 202.224.4822
Bill Frist Tennessee 202.224.3344
Rod Grams Minnesota 202.224.3244
Gordon H. Smith Oregon 202.224.3753

Democrats:

Frank R. Lautenberg (Ranking Minority Member) New Jersey 202.224.4744
Earnest F. Hollings S. Carolina 202.224.6121
Kent Conrad North Dakota 202.224.2043
Paul S. Sarbanes Maryland 202.224.4524
Barbara Boxer California 202.224.3553
Patty Murray Washington 202.224.2621
Ron Wyden Oregon 202.224.5244
Russell D. Feingold Wisconsin 202.224.5323
Tim Johnson South Dakota 202.224.5842
Richard J. Durbin Illinois 202.224.2152