Spend down- Hold officials accountable

Saturday, September 21, 2002

By Tom Monan

There is an adage that one picture is worth a thousand words. Today, one phone call may be worth a thousand votes.

I recently learned the Missouri budget for fiscal year 2003 eliminated Medicaid spend down payments to eligible Medicaid recipients. "Spend down" is synonymous with "co-pay" or "cost share ." Until the new guidelines take effect Oct. 1, Missouri's Medicaid spend down pays the portion of medical care or prescription cost that federal Medicare program does not cover. In effect, the Missouri Medicaid spend down is a supplemental insurance program funded by Missouri taxpayers and dollar matched at approximately 50 to 80 percent by the federal government.

I called Gov. Bob Holden's office to learn more about this and to find out who assisted this provision's inclusion into the Missouri budget. After several verbal pauses, the governor's staff person attempted to portray the new budget's spend down provision as the federal government forcing the governor's hand. However, she said, "He is working very hard to fix this problem."

My problem with this issue is my phone call to the governor's office and the impression his staff person gave me. If I had no other means to confirm the governor's story, I might very well have believed it.

After some research, I discovered a United Press International article that explained the situation in Missouri. It appears to me the governor is attempting to spin his approval of the Medicaid spend down elimination as a federal mandate. The UPI article lists the Missouri Division of Medical Services director, Greg Vadner, as saying, "He has made $286 million in cuts this past year, including $180 million in pharmacy costs and $20 million in lower payments to nursing homes. The problem is the Missouri legislature wrote those savings into the overall budget immediately, rather than allowing time for them to be worked in."

However, the ultimate responsibility for this new law that takes away up to 50 percent of a poor or disabled person's fixed income lies with Holden, who signed it.

I sincerely hope my impression of the governor is wrong, but with a party that in the past has striven to scare this country's senior citizen population with Republican elimination of medical care in order to garner votes, I will not be surprised to learn I am correct.

I find it very ironic that the Democrats in Missouri are the ones who are actually working to eliminate medical care for the poor and disabled. The Missouri governor has line-item veto authority and should have used it in this instance and vetoed the provision eliminating Medicaid spend down contained in House Bill 1111. The sponsors of HB 1111 were state Rep. Timothy P. Green of St. Louis and state Sen. John Russell of Lebanon, Mo. They should both be ashamed of their actions.

The Missouri legislature and governor performed a great disservice to the poor and disabled people of Missouri. The time has come for performance-based budgeting to apply to our elected officials as Senate Bill 509 from 2001 and Senate Bill 696 from this year's legislative session attempted to accomplish as a means for our state legislature to reward or punish all state agencies for superior or substandard performance.

The governor receives a salary of over $74,000 not counting benefits. The 2002 legislative session provides for each state representative to receive over $50,000 each year in salary and benefits. State senators probably receive about the same. I think it is time for our elected officials in the executive and legislative branches of our state government to receive the compensation they really deserve.

Tom Monan of Sikeston, Mo., is currently serving in the military.

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