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As governors eye Medicaid copays, doctor has warning

Associated Press
Published July 16, 2005


WASHINGTON - One woman visited the emergency room four times rather than pay a $1 fee for her insulin. That way she could get it for free.

Another found herself choosing between diapers for her grandchildren or medicine for her diabetes and heart problems. She, too, ended up in the hospital, treated by Dr. Kevin Larsen, a specialist in internal medicine in Minneapolis.

Larsen offered the two cases as examples of how some of the poorest patients were affected by Minnesota's decision to impose small copays for its Medicaid population two years ago. The fees - $3 for a brand-name drug and $1 for a generic drug - hardly seem high, Larsen says, but they made the drugs unaffordable.

"It's really incredible the little, tiny bit of disposable income that these patients have and how big a chunk that these seemingly marginal, nominal copays take out of that disposable income," he said.

As the nation's governors grapple with the soaring costs of Medicaid, they're eyeing copayments - patients' contributions to the cost of health care. At their meeting this weekend in Des Moines, Iowa, the governors are expected to recommend an easing of federal rules limiting what states can charge recipients.

The federal government must sign off on shifting more of the costs to patients, but the governors' recommendations will carry great influence as Congress seeks to reduce Medicaid spending by $10-billion over the next five years. This year, states and the federal government will spend about $329-billion on Medicaid, which serves about 53-million people.

The cost-sharing proposals are perhaps the most controversial of the recommendations, but among governors themselves, both Republican and Democratic, there is overwhelming support, said GOP Gov. Mike Huckabee of Arkansas, the incoming chairman of the National Governors Association.

"We all came to the conclusion that the only way to save it is to make it a more efficient, responsible program," Huckabee said in an interview with the Associated Press. "If nothing else, we're just asking that they give us a chance to implement this. They can always go back and say, "You guys screwed it up. It's not working for these poor families.' "

States, within limits, can require some beneficiaries to share in the costs of their health care. Typically, the copayment limits range from 50 cents to $3 per service.

And some segments of the population are pretty much exempt from cost-sharing requirements altogether, including children, pregnant women, people living in nursing homes or other institutions, and people receiving hospice care.