[Congressional Record Volume 140, Number 7 (Wednesday, February 2, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 2, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
   HEALTH CARE PROBLEMS CAUSED BY TOO MUCH GOVERNMENT, NOT TOO LITTLE

  (Mr. DUNCAN asked and was given permission to address the House for 1 
minute and to revise and extend his remarks and to include extraneous 
matter.)
  Mr. DUNCAN. Mr. Speaker, the problems we have in health care today 
are caused primarily because of too much government, not too little.
  Anyone who thinks differently should read today's Washington Post 
story about Medicaid.
  The sub-headline reads: ``Inconsistent, Seemingly Illogical Rules 
Leave Many Confused, Few Satisfied.''
  Talk about an omen of things to come.
  The story says about Medicaid: ``* * * with its maddening 
bureaucracy, high costs and variations from State to State, it now 
satisfies almost no one.''
  It quotes one of our most liberal Democratic Senators as saying 
Medicaid is ``a vile program, a horrible program'' that ``should be 
abolished.''
  The story goes on to quote a scholar from the Brookings Institution 
who jokingly says: ``Medicaid is a success story of the American 
political process. We make something so bad that we have to go to total 
reform.''
  I am sure that the well-intentioned people who wrote the original 
Medicaid law thought they had written a wonderful piece of legislation.
  Now it is little more than a horror story.
  These same types of horror stories will be said about the President's 
plan in a few years if we go along with it.
  The Federal Government is not capable of micro-managing our health 
care system. We will only make things worse if we get even more 
government into it than we now have.
  Mr. Speaker, I include for the Record an article on Medicaid which 
appeared in the Washington Post:

                [From the Washington Post, Feb. 2, 1994]

  A Mixed Blessing of Bureaucracy: Inconsistent, Seemingly Illogical 
                Rules Leave Many Confused, Few Satisfied

                            (By Dan Morgan)

       Medicaid has been a blessing to millions. Yet with its 
     maddening bureaucracy, high costs and variations from state 
     to state, it now satisfies almost no one.
       Sen. John D. ``Jay'' Rockefeller IV (D-W.Va.), a leading 
     advocate of health reform, has called Medicaid ``a vile 
     program, a horrible program,'' and added: ``Medicaid should 
     be abolished.''
       ``[Medicaid] is a success story of the American political 
     process,'' cracked Allen Schick, a visiting scholar at the 
     Brookings Institution. ``We make something so bad that we 
     have to go to total reform.''
       Medicaid's eligibility rules often seem to defy logic.
       Able-bodied, non-elderly single adults and childless 
     couples cannot qualify for Medicaid benefits no matter how 
     poor they are. Medicaid covers millions of mothers--but 
     relatively few fathers.
       In Tennessee, the program covers the catastrophic medical 
     bills of a 43-year old Nashville woman with a history of 
     heart attacks, comas and seizures. But in Texas and 12 other 
     states that have not adopted Medicaid's optional coverage of 
     such ``medically needy,'' the same woman might not be 
     eligible for any medical assistance.
       If a North Carolina single mother of three children, ages 
     10, 6 and 11 months, earns $1,600 a month, only the 11-month-
     old can get a Medicaid card, and the infant loses the 
     coverage after turning 1. If the woman's income drops just 
     $10 a month, however, Medicaid covers the 6-year-old and will 
     continue to cover the infant after it turns 1. But Medicaid 
     would not fully cover the mother unless her income dropped to 
     $594 a month, making her eligible through the state welfare 
     program.
       An acute care hospital could be reimbursed for housing a 
     35-year-old schizophrenic--but a psychiatric hospital could 
     not be.
       ``You'd have to be a Talmudic scholar to understand this 
     stuff,'' said a congressional aide with long experience with 
     Medicaid eligibility rules.


                         covering aids patients

       Among the more confusing rules are those that cover AIDS. 
     Persons who have developed AIDS, theoretically are eligible 
     for Medicaid--once they become permanently disabled and meet 
     income restrictions.
       But AIDS sufferers say there are a number of Catch-22s in 
     their situation.
       Early intervention with antiviral and prophylatic medicines 
     is generally believed to prolong life without disability. Yet 
     by the time AIDS patients qualify for Medicaid due to 
     permanent disability, it can be too late for drugs or medical 
     intervention to do much good.
       Permanently disabled adults who have exhausted their 
     resources are eligible for federal cash payments of $434 a 
     month under a program called Supplemental Security Income. 
     And once eligible for SSI, they automatically qualify for 
     Medicaid in most states.
       But if they have held jobs at which Social Security 
     contributions were deducted from their pay, they must first 
     apply for Social Security Disability Income (SSDI), whose 
     monthly cash benefits can exceed the income limits for SSI. 
     Without SSI, no Medicaid. SSDI makes them eligible for 
     Medicare, the government-run health insurance program that 
     covers the elderly and some disabled. But Medicare benefits 
     don't kick in until up to 24 months. In the meantime, they 
     are without Medicaid or Medicare.
       But for many AIDS patients, the battle starts long before 
     permanent disability--whose very definition is disputed 
     within the federal government. The Centers for Disease 
     Control and Prevention considers anyone with a T-cell count 
     of 200 or below--signifying significant damage to the immune 
     system--to be an AIDS sufferer for purposes of public health 
     statistics. But the Social Security Administration, which 
     rules on eligibility for SSI, uses a more restrictive 
     definition.


                        fear and pharmaceuticals

       Those who are not sick enough for any kind of federal 
     assistance look for help in other ways.
       AIDS activist Bryan Bradley of Houston, who is HIV 
     positive, knows firsthand about the fear the disease breeds--
     not just because of its physical terrors, but because of the 
     health care system's erratic response to it.
       When friends die, he said, he hurries to their homes and 
     removes all the medicines he can find. Last June, he 
     recalled, he got to a flat right after the body had been 
     taken out and found a ``load'' of pharmaceuticals.
       Bradley has private disability insurance and can get all 
     the medicines he needs. He said he collects the drugs for 
     others who are HIV positive and want to stay well for as long 
     as they can. Many fear losing their jobs, their health 
     insurance or both if they seek therapeutic drugs from the 
     Houston AIDS clinic or through their company policies.
       What Bradley does is against the law, but he said he 
     doesn't care who knows. ``They can do what they want to me,'' 
     he said.
       Houston does offer fallback services for those who don't 
     qualify for Medicaid. The Thomas Street AIDS clinic operates 
     with local tax dollars and grants from the federal Ryan White 
     program. And at any given time the two Harris County 
     hospitals are usually caring for 40 to 50 AIDS sufferers, 
     many of whom are charity patients with no insurance.
       But Lois Moore, president and chief executive officer of 
     the Harris County hospital district, acknowledged that 
     without a ``funded source'' of health coverage, such as 
     private insurance or Medicaid, an individual in Texas may 
     have trouble seeing a physician, is likely to get less 
     preventive care, and probably will end up going to an 
     overcrowded county hospital emergency room if in need of a 
     specialist.

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