WASHINGTON — Ordinarily, James Hunt doesn’t spend his weekdays meeting with lawmakers on Capitol Hill to protest proposed cuts in Medicaid, the state-federal health insurance program for the poor and disabled.
An anesthesiologist at University of Arkansas for Medical Sciences, Hunt is more accustomed to dealing with other doctors, nurses and patients.
Though his $326,964 annual pay might seem to make him an unlikely advocate for health programs for the poor, Hunt says cuts to Medicaid would hit his family hard.
When he and his wife, DeAnn Hunt, arrived in Washington last week, they found the city in full costcutting mode. They fear that proposed Medicaid cuts would put a part of the program they depend on in peril.
The Hunts participate in a program under Medicaid called TEFRA (named after the Tax Equity and Fiscal Responsibility Act of 1982), which allows families of all income levels to use the program to care for children with severe medical conditions, including autism, cerebral palsy and Down’s syndrome.
As negotiations between Democratic and Republican leaders continued to falter over the amount of spending cuts and tax increases that should accompany an increase in the nation’s debt ceiling, the Hunts and other advocates for federal safetynet programs arrived from Little Rock to make their case: Don’t let Medicaid get cut in the mix, they told Arkansas’ lawmakers.
Participating in the Medicaid program allows the Hunts to provide six hours of therapy a week for their 8-year-old son, Al, who was born with Down’s syndrome.
The cost for this help — if the Hunts had to pay it themselves — is more than $45,000 per year.
Hunt said children with Down’s syndrome who receive therapy early in life can develop into fully participating, taxpaying members of society who require less medical care as adults.
“They’re not the ones costing us money long-term because we spent Medicaid dollars on them early,” he said in between visits with Arkansas’ congressional delegation.
Lawmakers from both parties have insisted that a debtlimit increase must be paired with deep cuts in popular federal programs. President Barack Obama has called on both parties to take on their “sacred cows,” whether it is Democrats who want to protect entitlement programs such as Medicaid, Medicare and Social Security, or Republicans who are steadfast in their opposition to tax increases.
“Everyone needs to plan on getting a cut,” said Arkansas’ Sen. Mark Pryor, a Democrat. “We start with that premise.”
The close inspection of Medicaid being undertaken by lawmakers on Capitol Hill comes as Gov. Mike Beebe, a Democrat, and health experts and policymakers in Arkansas work on a planned overhaul of the program in the state.
Some members of Arkansas’ congressional delegation say funding cuts from Washington won’t necessarily force sick children and pregnant women off rolls.
“It depends on how you reform it,” said U.S. Rep. Tim Griffin, a Republican who said the notion that Medicaid will survive without structural changes is “complete fantasy.”
“If you want to avoid crippling cuts to those services,” he said, “you have to get away from the path they are on.”
But parents like the Hunts worry that any cost savings cannot be made without reducing eligibility rules or skimping on benefits.
Medicaid advocates say that federal cuts will leave states like Arkansas especially hard-hit. The program serves 750,000 patients in the state, and Arkansas relies on funds from federal taxpayers for 73 percent of its funding — a larger federal share than most states.
“Any attempt to limit the federal Medicaid dollars going to the state will have a devastating impact,” said Sharon Moone-Jochums, Easter Seals Arkansas’ president. “Our health-care infrastructure has been developed around the Medicaid system.”
But proponents of making cuts say the program is unsustainable because of the rising cost of medical care. In 2005, the federal share of Medicaid totaled $182 billion, nationally. This year, that number is expected to hit $273 billion, and further balloon to $497 billion by fiscal 2016, according to projections from the Office of Management and Budget.
U.S. Rep. Steve Womack, a Rogers Republican, said participants in entitlement programs like Medicaid have to be prepared to face benefit reductions.
“The people who complain, I’ve had them all in my office,” Womack said. “‘Don’t cut this, don’t cut that. Take care of this program, take care of that program.’”
“It’s unpleasant,” he said of potential cuts. “I understand that. I’m as pained about the need to cut these programs as anybody.
“The entitlement program itself is a dependency on government we have to begin to wean ourselves away from, because those are the principal drivers of deficits and debt,” he said.
Womack’s sentiment was echoed by each member of the Arkansas delegation, with the exception of U.S. Rep. Mike Ross, a Democrat.
Ross said he’d support changes to the program, as long as they didn’t reduce the level of service.
“I am not going to support any plan that cuts benefits for people on Medicaid, Medicare or Social Security,” Ross said. “There’s a big difference between reforms and cuts.”
The Hunts’ son, Al, undergoes two sessions each of speech, vocational and physical therapy every week. A week’s therapy, the Hunts said, would cost at least $900 in the private insurance market, and his policy will only cover one month of therapy at that schedule, each year.
As a medical professor at University of Arkansas for Medical Sciences College of Medicine, James Hunt earns too much to qualify for Medicaid. Through the TEFRA program, the Hunt’s pay a $458 monthly premium for Medicaid insurance coverage.
Hunt said that as an anesthesiologist — a doctor in high demand — his family would be in better shape than many to pay the full bill for Al’s care.
“We might be able to afford to pay the out-of-pocket expenses.” he said. “If I sold my house, we could move into a trailer park and I could drive a pickup truck. I’m not scared of that. That’s where I came from.”
About 3,000 Arkansas families participate in the TEFRA program. In fiscal 2011, the federal share was about $37 million and the state’s share about $9.7 million.
Advocates for keeping the entitlement programs funded at current levels say budget cuts will inevitably lead to slashed benefits, and the TEFRA recipients could be among the first to get cut.
“The states will have less money, and they’ll have to make cuts somewhere, said Joan Entmacher, vice president for family economic security at the National Women’s Law Center, a women’s advocacy group. “Will they throw pregnant women out of the program? Do they close down nursing homes? It’s going to be ugly.”
Robert Romano, an editor at Americans for Limited Government, a Washington group that advocates for reducing the size of the federal government, supports cutting Medicaid by nearly half.
“Our current funding level is too high,” he said. “Half the people who are eligible would no longer be eligible, or you’d have to reduce benefits,” he said.
But, he predicted, the pain involved would be worth it because it would help close the deficit and reduce the national debt, and in turn, allow the dollar to retain its place as the currency of choice for international investors.
“What’s worse, a recession right now or a catastrophic default and collapse of the dollar a decade from now?” he asked.
Front Section, Pages 1 on 07/19/2011