The tempo of the Iowa Legislature picked up this week. In addition to my membership on three standing committees and one budget sub-committee, I was appointed to a bi-partisan group of State Senators and Representatives who will consider ways to deal with the under-funding of Iowa’s Medicaid budget. The bipartisan group includes Chairs and Ranking Members of the House and Senate committees that deal with Medicaid and other health and human services issues.

Medicaid should not be confused with Medicare, which is solely a federal program of health services for all persons over the age of 65. Medicaid was created as Title XIX of the Social Security Act in 1965. It is a federal/state program, administered by the states, and funded with both federal and state dollars. Only those who meet specified eligibility criteria are entitled to services covered under the Medicaid program. Usually, eligibility involves a disability or medical condition, along with income guidelines. Historically, Medicaid has provided health care for children, pregnant women, elderly, and people with disabilities.

Iowa receives approximately $2 from the federal government for every $1 of state funds. With this arrangement, Iowans and Iowa health care providers receive $2.17 billion in federal and state health care dollars. Recently we have learned that the Bush administration plans to cut the federal deficit by cutting back on the federal share to Medicaid.

The demand for Medicaid has increased in the past several years for a variety of reasons. Iowans are turning to Medicaid when they lose jobs that provided their health insurance, and Iowa has a growing number of senior citizens who must depend on Medicaid for their long term care. Medicaid provides a health care safety net for many Iowans.

Although children are the largest group of Medicaid recipients, it is the elderly that are the most costly. Hospital costs and nursing home costs for our frail elderly are the largest expense in the Medicaid program. I worked with a legislative committee this past summer and fall to address the long term care needs of seniors and people with disabilities. We hope to accomplish this by establishing more home and community based services, so that people have alternatives to more costly nursing home care. While some of our elderly citizens certainly need nursing home care, we must have a balance of nursing home care and in-home care services from which people can choose.

A cost-saving provision that I continue to work on is the creation of a chronic disease management program for Medicaid recipients. We know that diseases such as asthma, diabetes, and depression can be effectively managed, and, with proper management, do not require as many expensive emergency room visits or hospitalizations.

Another recommendation for cost containment is the establishment of an interagency pharmaceutical bulk purchasing council within the Dept. of Public Health. This would bring all the state agencies that purchase drugs together to form a buying cooperative. The state could then purchase pharmaceuticals in bulk for the state mental health institutes, prisons, community correctional facilities, and our children and youth homes.

A partial solution to the escalating Medicaid costs is an increase in tobacco taxes. Currently, Iowa taxes cigarettes at .36˘ per pack, much lower than most neighboring states. In the past year, Medicaid paid out $235 million for tobacco related illnesses. At .36˘ per pack, the State receives only $88 million. Increasing the excise tax on cigarettes will not solve our Medicaid budget problem, but it will provide some of the shortfall and, more importantly, it will save the lives of Iowans who quit smoking because of the increased cost.

We are hopeful that our congressional delegation will fight for adequate health care for the one of every ten Iowans who relies on Medicaid. We especially look to Senator Grassley, Chair of the powerful Senate Finance Committee and Congressman Nussle, Chair of the House Budget Committee, and our Representative, Congressman Leach, to stop this move to balance the federal budget on the backs of the most vulnerable citizens of Iowa.

Many of us have been taught to consider “the least of these”, that is, the most vulnerable citizens of our state and country. I hope you can help us by contacting Senator Grassley and Congressmen Nussle and Leach, asking them to support our efforts to provide health care for the “least of these” right here in Iowa. They will literally be making life and death decisions about their fellow Iowans.

You can write me at the State Capitol, Des Moines, IA 50319; call me at 515/281-7328 or e-mail me at ro.foege@legis.state.ia.us.

Ro

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