[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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