Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, October 10, 1995 TAG: 9510100126
SECTION: EDITORIAL PAGE: EDITORIAL EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
Most states will be. And despite Gov. George Allen's participation in talks among GOP governors on how to divvy up federal dollars, Virginia would lose $3.3 billion in expected Medicaid money over seven years under plans now moving through Congress. In those same years, Virginia's elderly population will be growing.
This prospect is eagerly awaited by the Allen administration: Along with the loss of billions of federal dollars, the state will be able to free itself from the "crushing boot-heel" of federal standards.
The commonwealth likely can realize some savings through increased efficiencies. But $3 billion is a lot to squeeze out of a program that Virginia already funds conservatively compared to efforts in more liberal states. Virginia ranks 45th among states for the amount of federal dollars per poor person it receives.
The new block-grant formula is supposed to keep Virginia's relatively small, though still hugely expensive, Medicaid program from being penalized for the state's earlier fiscal responsibility. It also would leave Virginia exactly where it was - 45th in federal dollars per poor person, according to the Virginia Hospital Association.
Medicaid is just for the poor, some might say. Slackers, deadbeats, welfare cheats. Why worry about them?
Well, one point to consider is that most nursing-home residents in Virginia are on Medicaid - in part because many middle-class people who have to go into nursing homes are bankrupted by the cost.
And what are the federal standards from which the states will be "freed"? Among those that would be abolished by the House bill are rules to prevent nursing homes from involuntarily discharging patients (when, for instance, they run out of money), or unnecessarily tying down or drugging patients (who require so much less staff time, and thus less expense, when they can be quietly shelved).
The jackbooted feds also would no longer prohibit states from forcing spouses of nursing-home residents to sell their homes and cars, or from requiring children to pay their parents' nursing-home bills.
Families do have a responsibility to care for their own. But without any protections, the crushing expense of long-term care could drive elderly spouses out of their homes, deny a new generation the savings to pay for their kids' college educations, and push more hard-working families into poverty.
Yes, some families have abused the system by hiding parents' assets to protect inheritances, leaving the taxpayer to pick up the bill. Rules have been tightened. They need to be tougher still. Some states, given the freedom to experiment, will surely find smarter, more efficient ways to care long-term for this vulnerable population.
But no one should imagine that simply cutting back dollars and converting them to fixed, block grants will in itself prove a panacea. Changing the funding mechanism doesn't address the basic need for health-care reform, including reform of long-term care. And block grants don't take into account states' changing economic conditions. More suffering may result when financially squeezed states have no uniform, minimum standards to meet.
Don't worry, GOP congressmen say. States will protect their people. Well, in this state, the governor tried to cut funds for Meals on Wheels.
by CNB