By ROBERT PEAR, NY Times, August 18, 2005
WASHINGTON, Aug. 17 - The Bush administration clashed with doctors on Wednesday over the merits of a proposal to charge higher co-payments to Medicaid recipients, with doctors warning that the fees could deter some poor people from seeking necessary medical care.
The debate came at a meeting of a federal advisory panel appointed by the administration to help rein in the growth of Medicaid, which provides health insurance to more than 50 million low-income people.
Congress may use the panel's advice as a basis for legislation this fall.
Under the current Medicaid law and rules, co-payments for most adults cannot exceed $3 for goods and services like prescription drugs, visits to doctors and outpatient hospital visits. For children younger than 18, co-payments are not allowed.
The panel, known as the Medicaid Commission, is considering an option that would allow states to charge higher co-payments, $5 for adults and $3 for children.
Michael J. O'Grady, a member of the panel who is also an assistant secretary of health and human services, said the higher co-payments would make beneficiaries more "price-sensitive" and would not impose an undue burden.
"We are talking about the price of a pack of cigarettes," Mr. O'Grady said. He noted that the maximum co-payments had not been changed since the early 1980's.
Under the proposal, the Congressional Budget Office estimates, Medicaid recipients would pay $4 billion in additional charges over the next five years.
Dennis G. Smith, a top federal Medicaid official, said that was not a large amount in the context of a program expected to cost the federal government and the states $2 trillion in the next five years.
But Dr. John C. Nelson, a former president of the American Medical Association who is a commission member, said: "If we raise the co-payment, some people will not get the care they need. These are real people."
A person with chronic illnesses who forgoes medicine because of the higher co-payment could end up in a hospital emergency room, which costs much more, said Dr. Nelson, an obstetrician and gynecologist from Salt Lake City.
Democrats have been leery of the commission, saying it would simply ratify budget cuts proposed by President Bush. But the panel made clear Wednesday that it would not rubber-stamp proposals by Mr. Bush or the National Governors Association.
Dr. Carol D. Berkowitz, a commission member who is president of the American Academy of Pediatrics, said that co-payments of $3 to $5 could quickly add up to substantial costs for a low-income family with four children.
Another commission member, Julie Beckett, said that a $5 co-payment for each drug and doctor's visit "is a lot if you have multiple chronic conditions and multiple needs." Ms. Beckett is policy director of Family Voices, an advocacy group for children with special health care needs.
Mr. Smith said Medicaid had begun as a health care program for welfare recipients, but now served many mothers and children in families with incomes "well above the poverty level."
The federal government has given states hundreds of waivers allowing them to experiment with changes in Medicaid. But Raymond C. Scheppach, executive director of the National Governors Association, said Medicaid was still "a very rigid, inflexible program."