While most of us are focused on insurance or universal care, the Bush Administration has been incrementally shredding Iowa’s existing public health safety net in ways that have yet to become apparent.  The most recent assault on our public health care infrastructure is escaping the notice of mainstream media and citizen journalists alike, probably because it is not easily explained. I am referring to a proposed set of arcane regulation changes by the Center for Medicaid and Medicare Services (CMS) which, if enacted, will result in $15 billion dollars in cuts over five years to service providers, closing or scaling back emergency rooms, medical education and school based services in Iowa communities.

The proposed CMS regulations will drastically reduce resources for programs as diverse as  graduate medical education (FR72:28930-28936), hospital and ER care (FR72:29748-29836), outpatient hospital and clinic services (FR72-55158-55166), school based health programs including enrollment efforts (FR73635-73651), services to individuals with disabilities (FR72:45201), and case management services (FR72:68077-68093).  Moreover, the rules changes severely restrict   (FR72-73708-73720)or eliminate avenues for appeal of future CMS decisions.

The most dramatic of the proposed changes will enforce draconian cuts to public and teaching hospitals, and eliminate public subsidies for training the next generation of physicians.  If enacted, these rules could leave low income and rural communities completely without trauma coverage, and some states with no way to train new doctors. The rules changes will impede homeland security efforts to prepare communities for pandemics, terrorist attacks or other disasters.

In a  letter to Henry Waxman dated February 14, 2008, Dr. Bruce A. Chernoff, the Director and Chief Medical Officer of Los Angeles County Health Services wrote, “Within the last five years, ten hospitals in the [LA] county have either shut down their ER or completely closed the hospital.  If a series of Medicaid regulations currently awaiting implementation by the US Department of Health and Human Services (HHS) are allowed to go into effect, ER care in the county will be devastated.”

Arnold Schwartzenegger, the Republican Governor of California agrees, along with his colleagues on both sides of the aisle. The New York Times reported strong support from Republican and Democratic governors alike for a moratorium on the proposed rules.  A group of 17 states called the rules “simply awful policy” according to the NYT.

While heavily populated states such as New York and California may lose greater amounts of funding, rural states such as Iowa and New Mexico will also be heavily impacted.  “In New Mexico, sometimes there is only one hospital for a multi-county region larger than an eastern state.  If you lose that hospital, then there is no trauma care,” said Lorenzo Valdez, county manager of Rio Arriba County which is approximately the size of Massachusetts.

In addition to these rules changes, the administration has announced its intent to publish changes to three more mystery rules.  As these changes have not yet been published, it is impossible to predict their future impact.

Most of the $15 billion dollars of cost for indigent care will be shifted onto state and local government at a time of economic slowdown.  States and counties will be hard pressed to raise revenues to offset federal losses. Moreover, states and counties that are economically disadvantaged will experience greater impact from these cuts for two reasons: they have poorer populations which are unable to bear the disproportionate levels of taxation necessary to preserve their healthcare infrastructure; and, because the poor are the first to lose insurance, need in these communities will increase at a faster rate.  Finally, economically disadvantaged local governments are already forced to devote high percentages of their budgets to unfunded federal mandates such as the jail expenditures caused by mandatory minimum sentencing, and hence, will have less budget available to offset health care losses.

The proposed Medicaid Rules Changes will exacerbate the growing disparity between those who can access health care in America and those that cannot.

Last year, at the request of the nation’s governors, Congress repeatedly acted on a bi-partisan basis to delay the implementation of new rules through a series of moratoria.  This year, 139 organizations have signed a letter to Congressional leaders requesting a blanket moratorium on changes to all Medicaid rules for a one year period.

In addition, there is a bipartisan effort in both houses to introduce a moratorium on two of the most devastating rules changes.  Senators Jeff Bingaman (D-NM), Elizabeth Dole (R-NC) and 22 co-sponsors have introduced S 2460 extending a one year moratorium on rules changes targeting subsidies to public and teaching hospitals.  Representatives Eliot Engel (D-NY) and Sue Myrick (R-NC) along with 208 co-sponsors have introduced HR 3533, the “Save Our Public and Teaching Hospitals Act.”

“New Mexico depends on Medicaid funding to ensure the state’s most vulnerable citizens have access to health care.  The proposed rules would severely restrict the state’s ability to provide medical services to uninsured patients,” Bingaman said for this article.  “This is an issue that will impact states nation wide and I strongly urge my colleagues to support this bill.”

While Senator Hillary Clinton has signed on as a co-sponsor of S 2460, Senators Barak Obama and John McCain have not.

Actions You Can Take

You can contact Senator Charles Grassley (R-IA), the ranking Republican on the Senate Finance Committee at http://grassley.senate.gov/ind… or (202) 224-3744 and politely let him know you would appreciate his help passing S 2460 as well as a one year moratorium on all CMS rules changes. Remember, this is a bi-partisan issue and we need Republican support.

You can contact Iowa Senator Tom Harkin and your representative and ask them to support these bills along with a one year moratorium on all CMS rules changes.

You can contact Senator Harry Reid (D-NV) at (202) 224-3542 and tell him to help pass S 2460 along with a one year moratorium on all CMS rules changes.

You can contact House Speaker Nancy Pelosi (D-CA) at 202) 225-0100 and ask her to support HR 3533 as well as a one year moratorium on all CMS rules changes.

You can contact Senator Hillary Rodham Clinton (D-NY) at (202) 224-4451 and thank her for her support for S 2460. Ask her to support a one year moratorium on all CMS rules changes and to make stoppage of CMS rules changes a platform in her campaign.

You can contact Senator Barak Obama (D-IL) at (202) 224-2854 and ask him to please support S 2460 as well as a one year moratorium on all CMS rules changes.  Ask him to make the moratorium a talking point in his campaign.

You can contact Senator John McCain (R-AZ) at (202) 224-2235 and ask him to please support S 2460 as well as a one year moratorium on all CMS rules changes.  Ask him to make the moratorium a talking point in his campaign.

Thank you for your support on this very important issue!