Medicaid

There's always something pushing reform of the American health-care system to the bottom of the agenda. This week, out of the blue, it was a Soviet coup. That's not exactly how the National Governors' Association had planned it. In an August that was shaping up dull and slow, they'd counted on this week's Seattle conference to rekindle interest in a matter that the states want dealt with in the worst way: Health costs are eating state budgets up as they rise 25 percent annually. The governors didn't get their wish, obviously.

As a Republican, Jamie Coleman might be expected to side with Pennsylvania Gov. Corbett when he wrote that an expansion of federal Medicaid - health coverage for the poor - would be a bad idea for state taxpayers. But as a nurse at the Hershey Medical Center, she has a different point of view: "There will be some impact," Coleman said. "What that means we don't know yet. We're not sure if it is going to cause layoffs, or if there will be some facilities in the state closing down.

Elderly residents who spent the last of their life savings to be cared for at some assisted-living facilities in South Jersey were improperly discharged when they qualified for Medicaid, an 18-month investigation by a state watchdog has found. Assisted Living Concepts, a Wisconsin company that operates the facilities, "broke its trust with dozens of elderly residents who believed they would be permitted to age in place once their private funds were exhausted," New Jersey Public Advocate Ronald K. Chen said.

Deborah Zubow is coordinator of the Healthwatch Help Line at Philadelphia Citizens for Children and Youth More bureaucracy: not exactly what our health-care system needs, but it's what we're getting, starting Saturday. On that day, our national government, with nothing more important to do than interfere with state-administered health insurance programs, will begin to require that every U.S. citizen who applies for Medicaid present, in person, yet another pile of documents and then wait even longer than before for access to a doctor for even the simplest and most basic medical care.

"One of the greatest losses in not expanding Medicaid [is the loss of] opportunity to put together all the various pieces of the system. " - Al Black, COO, Hospital of the University of Pennsylvania. " . . . We cannot ignore the $4.1 billion in state-only taxpayer costs over the next eight years that could occur as a result of expanding Medicaid in Pennsylvania. " - Carey Miller, spokeswoman, Pennsylvania Department of Welfare. "It's confirmation of a trend.

Seven-year-old Alicia Hoelle of Gibbstown has had a challenging life. She suffers from hypoganglionosis, a disorder that has rendered her intestines useless and means that she must be nourished through catheters in her chest and stomach. A private nurse cares for Alicia, who, despite her disability, likes to swim and will begin second grade at the Broad Street School next month. Alicia's care costs about $330,000 a year, said her mother, Rose Hoelle. What the family's medical insurance doesn't pay, Medicaid, a federal medical- assistance program, does.

The impact of the Hobson's choice on Medicaid that the White House has offered cash-strapped states like Pennsylvania and New Jersey is becoming clear - and clearly distressing. The impact will unfold through thousands of chronic ailments left untreated, thousands of illnesses allowed to linger until they turn serious. This will force thousands of lost work days, burden hundreds of emergency rooms, and threaten some hospitals and nursing homes with collapse. Though in the short run some tax money may be saved, in the long run this all will cost middle-class America far more in higher health insurance premiums.

Gov. Ridge's plan to spend Pennsylvania's tobacco settlement money to increase health care insurance coverage in Pennsylvania is a good start. But not good enough. It doesn't make a meaningful dent in the problems posed by 1.2 million Pennsylvanians without health insurance. There are better ways to go: Extra money from the 41 cents-a-pack tax increase proposed last week by State Sen. Vincent Hughes (D, Phila.), and millions in federal funds the state could get if it expanded Medicaid would make a big difference.

Lawyers representing the poor are expected to file suit in federal court this week seeking to block cuts in medical and dental services that are to take effect Friday for more than 730,000 Medicaid recipients in Pennsylvania. Richard Weishaupt, an attorney for Community Legal Services of Philadelphia, said yesterday the agency would ask the court for a preliminary injunction that would maintain current Medicaid services until the lawsuit could be heard. He said the suit would be filed tomorrow.

Gerald F. Radke, Pennsylvania's deputy Welfare Secretary, would like to clone a new Medicaid system that he says runs rings around the old, catch-as- catch-can way of getting care. It's called HealthPass, and operates roughly like a private HMO for 79,000 poor people in South and West Philadelphia. For five years, it has been examined, dissected, cursed and praised. Now Mr. Radke wants to take it on the road. To Pittsburgh, for starters. To its detractors, HealthPass seems more like HealthPunt, focusing on costs, not improved quality; skating now and then on the brink of financial chaos; stoking - because of its poor-only clientele - suspicions of separate, second-rate treatment.