View Full Version : Medicaid cuts could carry a political cost, too

Mr. Laz
02-18-2005, 12:49 PM
Posted on Fri, Feb. 18, 2005

Medicaid cuts could carry a political cost, too

The Kansas City Star

GERSTER, Mo. — Gary Ruckel, like most rural Missourians, backed Matt Blunt for governor last fall and voted other Republicans into legislative seats.

Ruckel agreed with Blunt on issues such as gun control and gay marriage, but he was not considering a subject that hit much closer to home: medical care.

So when Blunt proposed cuts in Medicaid last month that could cost Ruckel and his wife, Vivian Ruckel, some services, the couple had second thoughts about backing Republicans.

“It kind of jumps back and kicks you in the teeth, is what it does, because I wasn't planning on this,” said Ruckel, who lives about 50 miles north of Springfield. “If they cut back on Medicaid, it's going to crucify us, because we don't make that much.”

Ruckel's story is familiar in rural Missouri. More than half of Medicaid recipients in Missouri live outside the Kansas City and the St. Louis areas.

Those rural areas voted heavily for Blunt, who carried 100 of 107 counties outside the state's two largest metropolitan areas.

Those counties, most relatively poor, also elected primarily Republicans to state House and Senate seats. In fact, 10 of the 12 House districts with the lowest median household incomes in Missouri are represented by Republicans.

Now, Blunt is asking those Republicans in the Missouri House and the Senate to back Medicaid cuts that would affect many of their constituents. Roughly 20 percent of those rural Missouri residents are getting Medicaid help.

Rural Republican lawmakers could feel on the spot.

“The governor will pull them one way, and the constituents will pull them another,” said David Webber, political science professor at the University of Missouri-Columbia. “Sooner or later that will become a matter of some tension in the state legislature.”

Reining in costs

Republicans said something must be done to contain state spending on medical care.

Blunt points to a study by the National Association of State Budget Officers showing 30.7 percent of state spending in Missouri in 2003 went for Medicaid and related services, the second-highest percentage in the nation.

“The question is, ‘What can we afford to do?' ” said Rep. Bob Behnen, a Kirksville Republican whose district is among the 12 poorest rural districts in the state. “Are we doing someone a favor by raising their eligibility as we have over the years and basically subjecting them to something they will be dependent on?”

The proposed cuts should not be a surprise, said Rep. Doug Ervin, a Holt Republican. “We've been out there saying we support a smaller government, and I've campaigned on the notion of limited government and less taxes,” Ervin said. “Saying that, we've also made it very clear we need to take care of people who really need the help the most.”

Ruckel and his wife, both 64, said they were among those in need. Ruckel, a former police officer and prison guard, has emphysema, arthritis, a spinal defect and other ailments. His wife is in worse shape, suffering heart and lung ailments, and kidney disease. She tires quickly and cannot do much outside the home. Ruckel is on nine medications; his wife is on 21.

With a combined income of $1,357 a month, mostly from Social Security, they qualify for full payment of medical and pharmacy bills through Medicaid. Both are classified as workers with disabilities because Ruckel works on lawn mowers and his wife does sewing, making about $60 a month combined, he said.

In addition to full coverage of medical bills, the Ruckels get state-paid home care services. Someone from the organization On My Own Inc. is at their home seven days a week for six hours a day to do housework, cooking and personal care.

The Medical Assistance for Workers With Disabilities program the Ruckels and 9,500 other Missouri residents are on would be eliminated under the Blunt plan.

Because of their age and disabilities, the Ruckels could apply for services under another program. But they would get a cut in home care services and at worst would have to pay $382 a month toward medical and pharmacy bills under program changes, said Denise Cross, a division director in the Department of Social Services.

The Ruckels live modestly, staying in a house Ruckel is buying from his mother.

“I have worked hard all my life, and we got to a point where we are having a hard time, and they are talking about cutting back on us,” Ruckel said.

Legislators' dilemma

Ruckel's state representative, Republican Larry Wilson of nearby Flemington, said he was sensitive to the couple's plight. Wilson, 56, said he grew up on a farm in a family challenged to make ends meet.

“We had no running water until I was a senior in high school,” Wilson said. “I know how it is; I really do.”

Wilson said he knew some of his constituents were in need, and balancing their interests with the state's budget was not easy.

“It's difficult; it really is,” Wilson said. “It's a problem we have in state government that we only have so many dollars to work with.”

Blunt's plan would reduce or eliminate Medicaid services for 122,557 persons in Missouri, or about 12 percent of all people now covered, according to the Department of Social Services. It would save $626 million.

Blunt spokesman Spence Jackson said that the governor did not take the proposed cuts lightly but that they were overdue.

“People in rural Missouri as well as people in Kansas City and other parts of the state want to see a government that lives within its means,” Jackson said.

Jackson said the governor had the support of rural Republican lawmakers on the proposed Medicaid cuts, though several said they wanted to look at the plans.

“Everybody has to remember that the governor's proposed budget is just that — proposed,” said Rep. Shannon Cooper, a Clinton Republican.

Cooper said about 20 percent of his constituents were receiving Medicaid, but he noted they were not the only people he represented. “I have to look out for the concerns of the other 80 percent who make it quite clear they do not want to pay any more taxes,” Cooper said.

Two persons who have received Medicaid services in Cooper's district said they believed the proposed cuts were misguided.

“We are helping people worldwide, and we are supposed to be the richest country in the world, yet we keep cutting back,” said LuCinder Coke, 46, a Clinton resident who suffers severe depression and would lose some Medicaid-paid counseling under the Blunt plan. “We ought to help our own before we help others.”

Coke and Joshua Kelley, 26, get help through Pathways Community Behavioral Healthcare in Clinton, which gets reimbursed by the state for Medicaid patients.

Neither voted for Blunt.

Kelley, of Springfield, is spending a month at a Pathways residential treatment center for a drug problem. That type of program would be eliminated under the Blunt plan, said Pathways treatment center supervisor Sylvan Ward.

Kelley said that Pathways was the most effective treatment he had received and that eliminating the program could keep people like him from getting better — to the detriment of the state, should he get back into drugs.

“I believe it's worth the government's investment,” he said of his treatment.

Effects on employers

The proposed Medicaid cuts would affect budgets and staffs of organizations, clinics, doctors and other health professionals who now provide Medicaid services, Democratic lawmakers said.

“My hospitals and clinics and businesses are going to suffer,” said Rep. J.C. Kuessner, an Eminence Democrat whose district in southeast Missouri is one of the state's poorest. “A lot of businesses in my area, because of the high (Medicaid patient) numbers, are staffed accordingly.” At one hospital, 75 percent of patients are on Medicaid, he said.

People can qualify for Medicaid for various reasons, with income being the basic determining factor.

About half the people who would be affected by the proposed Medicaid cuts would qualify because their incomes are at or below 75 percent of federal poverty thresholds. For a family of two that would mean income of no more than $781 a month. The qualifying percentage would drop to 30 percent of poverty under the Blunt plan. A family of two could have a monthly income of no more than $312.

Democrats say cutting Medicaid would only shift costs.

“Sooner or later a hospital has to get paid,” said Sen. Patrick Dougherty, a St. Louis Democrat. “And a lot of them make it up on the people who have insurance.”

To reach Kevin Murphy,

call (816) 234-4464 or send e-mail to kmurphy@kcstar.com.

02-18-2005, 01:12 PM
hah. That's just about the sort of treatment I would expect a Republican initiative to receive from the Kansas City Star.

02-19-2005, 06:17 PM
Yup, Blunt is going to take a lot of flack. But rampant spending has really hurt Missouri over the last several years. If we balance and actually work the budget out, then he will be re-elected. If we fail to get in the black, he will be gone.

The question that begs is:

Do I want Matt Blunt reducing social programs along with many others
Do I want Bob Holden stealing from my school district to pay failing ones like KC and St Louis?

Do I want Matt Blunt killing overt spending like the government supplied license branches
Kathleen Sebelluis spending hundreds of thousands of dollars on slogans like "Kansas, sure is big this week"?

At least he is trying to make a difference for the entire state of Missouri.

02-19-2005, 08:40 PM
The biggest concern of his term doesn't appear to have been his innaugural ball, so he's already got Holden beat.