Medicaid realities

The debate over what to do about Medicaid in Missouri is one of the hottest topics to spread across the state in years.

Proposals by Gov. Matt Blunt in his very first budget plan are aimed at controlling the rapidly growing costs of the health-care program for the needy.

But advocates for Medicaid recipients have launched one of the biggest lobbying efforts in history to save every dime of benefits without regard for abuse of the system and outright fraud.

Without a change in course, the cost of Medicaid programs in Missouri would consume all of the state's general revenue in the not-too-distant future. Already most states, including Missouri, spend as much -- or more -- on Medicaid than on K-12 public education.

Look at these statistics drawn from a national survey of Medicaid programs by Jon Sawyer, Washington bureau chief of the St. Louis Post-Dispatch:

* Many other states -- except for Illinois and Maine -- have already taken steps to rein in Medicaid spending in ways proposed by Blunt. Some states have made far deeper cuts than those proposed in Missouri.

* In Tennessee, Democratic Gov. Phil Bredeson's proposed cuts are three times bigger than those backed by Blunt, a Republican.

* Much of the expansion in Medicaid programs across the nation can be attributed to a "hodgepodge of state laws enacted with the assurance that the federal government will pick up 50 percent or more of the tab." This has produced a consensus, Sawyer's report says, that Medicaid has become a "recipe for inconsistency and inequity."

* The Medicaid system covers 53 million individuals nationwide, "including 8 million Americans with incomes above 150 percent of the federal poverty level and leaves uncovered another 18 million with incomes below" the poverty level.

* Missouri's Medicaid rolls more than doubled from 395,086 in 1991 to 995,176 at the end of 2004. Blunt's proposal would lower income levels for Medicaid eligibility -- a step that already has been taken twice before in 2002 and 2004 -- and would eliminate 89,000 participants.

It's easy to see why Blunt's budget planners and state administrations across the country are so alarmed about Medicaid. Funding does not come from a bottomless pot, and states must live within their constitutional mandates to spend no more than is taken in.

Perhaps the most overlooked statistic can be found in state Sen. Jason Crowell's commentary elsewhere on this page. The senator from Cape Girardeau observes:

"Even with the proposed reforms ... Missouri will spend at least $37 million more this year on Medicaid than last. More than 900,000 people, or 15 percent of the population, will continue to receive Medicaid welfare benefits. That translates to one out of every six people in Missouri, making Missouri's percentage of population on Medicaid greater than 35 other states."

No one likes to lose government benefits, and advocates for the needy are making their messages heard in Jefferson City.

But the governor and the Missouri Legislature have a responsibility to tackle this "Frankenstein," as Matt Sala, director of health and human services for the National Governors Association described the situation.

We agree.