Medicaid Cuts Hurt At The State Level

CHICAGO — In Illinois, a pharmacist closes his business because of late Medicaid payments. In Arizona, a young father’s liver transplant is canceled because Medicaid suddenly won’t pay for it. In California, dentists pull teeth that could be saved because Medicaid doesn’t pay for root canals.

Across the country, state lawmakers have taken harsh actions to try to rein in the budget-busting costs of the health care program that serves 58 million poor and disabled Americans. Some states have cut payments to doctors, paid bills late and trimmed benefits such as insulin pumps, obesity surgery and hospice care.

Lawmakers are bracing for more work when they reconvene in January. Some states face multibillion-dollar deficits. Federal stimulus money for Medicaid is soon to evaporate. And Medicaid enrollment has never been higher because of job losses.

In the view of some lawmakers, Medicaid has become a monster, and it’s eating the budget. In Illinois, Medicaid sucks up more money than elementary, secondary and higher education combined.

“Medicaid is such a large, complicated part of our budget problem, that to get our hands around it is very difficult. It’s that big. It’s that bad,” said Illinois Sen. Dale Righter, a Republican and co-chairman of a bipartisan panel to reform Medicaid in Illinois, where nearly 30 percent of total spending goes to the program.

Medicaid costs are shared by the federal and state governments. It’s not just the poor and disabled who benefit. Wealthier people do, too, such as when middle-class families with elderly parents in nursing homes are relieved of financial pressure after Medicaid starts picking up the bills.

Contrary to stereotype, it’s the elderly and disabled who cost nearly 70 cents of every Medicaid dollar, not the single mother and her children.

In California, Medicaid no longer pays for many adult dental services. But it still pays for extractions, that is, tooth-pulling. The unintended consequence: Medicaid patients tell dentists to pull teeth that could be saved.

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