By Kevin Sack and Robert Pear, New York Times | February 19, 2010
WASHINGTON – Facing relentless fiscal pressure and exploding demand for government health care, virtually every state is making or considering substantial cuts in Medicaid, even as Democrats push to add 15 million people to the rolls.
Because they are temporarily barred from reducing eligibility, states have been left to cut optional benefits, like dental and vision care, and reduce payments to doctors and other health care providers.
In some states, governors are trying to avoid the deepest cuts by pushing for increases in tobacco taxes or new levies on hospitals and doctors, but many of those proposals are running into election-year trouble in conservative legislatures.
In Nevada, which faces an $881 million budget gap, Governor Jim Gibbons, a Republican, proposed this month to end Medicaid coverage of adult day care, eyeglasses, hearing aids, and dentures, and, for a savings of $829,304, to reduce the number of diapers provided monthly to incontinent adults (to 186 from 300).
The Medicaid program already pays doctors and hospitals at levels well below those of Medicare and private insurance, and often below actual costs. Large numbers of doctors, therefore, do not accept Medicaid patients, and payment cuts may further discourage participation in the program, which primarily serves low-income children, disabled adults, and nursing home residents.
In Kansas, a 10 percent cut in provider payments that took effect on Jan. 1 has prompted such an outcry that Governor Mark Parkinson, who imposed it, now wants to restore the money by raising tobacco and sales taxes.
Even if Parkinson, a Democrat, overcomes resistance in his Republican-controlled Legislature, it will be too late for Dr. C. Joseph Beck, a Wichita ophthalmologist who informed his Medicaid patients last month that he could no longer afford to treat them.
Beck said that over an eight-month period last year, his practice wrote off $36,000 in losses from treating 17 Medicaid patients. The state-imposed payment cut, he said, was “the final straw.’’
Concerns about health care costs are likely to dominate the winter meeting of the National Governors Association, which begins tomorrow in Washington.