2005年NPR美国国家公共电台五月-Debating Medicaid and Morality in Missour

This is Morning Edition from NPR news. I’m Steven Inskeep, as we reported on this program medicaid has become the single biggest budget item for most states. Nearly all of them are trying to limit the growth of the health program for the poor and no state is going after medicaid more aggressively than Missouri. Politicians there have cut 90,000 people from the program and have laid plans to end it entirely 1. The cuts have opened a moral divide with some preachers expressing outrage 2. The governor, a devout 3 Christian 4, defends the cuts as morally correct. Frank Morris of member station KCUR in Kansas City reports:

As Missouri’s governor, Matt Blunt and the Republican legislator of leadership found out this year , slashing 5 medicaid can provoke a noisy fight.

Governor Blunt, this is pure unadulterated sin. Sin, it’s just sin. Sin, that’s what it is. Let’s call sin what sin is! Wrong! Sin!

Sixty or so activists 6 held their prayer vigil outside Truman Medical Center, one of Kansas City’s big indigent 7 care hospitals. Earlier, protestors chained their wheelchairs to a door of the State House. But Governor Blunt hasn’t wavered from his position that failing to cut medicaid would force him to raise taxes, and that raising taxes is wrong.

I don't know what's moral about a tax increase on hard-working Missouri families. And if you oppose to reducing spending in state government, that’s the only option.

Missouri’s medicaid program has more than doubled in size in the past decade, expanding to cover almost one in five citizens. Governor Blunt says continually raising taxes to cover the mushrooming costs of insuring all those people would poison the state’s economy; He says he's made hard choices to detain the program and the governor believes that under some circumstances cutting some people off medicaid will actually do them good. Jessica Robinson is the governor's press secretary.

Concern or fear of losing health coverage 8 could become motivation enough to learn a new trade or to seek out a position that would otherwise provide that coverage.

Ok… I mean… alright…

Angel Bridgewater is helping 9 her 7-year-old niece with homework on the front porch in a tough inner city neighborhood as a police helicopter hovers 10 nearby. As of this year, Bridgewater's six-dollar-seventy-cent an hour part-time job at McDonalds is much too rich to qualify for state medical assistance, though she supports three kids, she will now have to make less than eighty-six dollars a week, to qualify for medicaid. Before the cuts she qualified 11 while earning about 300 dollars a week. The new eligibility 12 standard is the lowest allowed by federal law and reflects priorities Bridgewater calls sickening.

We're human beings and we need help. When we need help, and that should be the last thing they should try to cut .

If Bridgewater got a better job and made more money, she could lose her rent and child-care subsidies 13, and perhaps have to pay for her children's state health insurance. As it is, she says a serious illness or injury could land her and her kids on the street. Medical bills would be the least of her worries.

If I get really sick, or I have to really go to emergency room. Am I gonna Truman Medical Center and just let them bill me, and just let them bill me.

Hospitals won't be the only financial losers. Federal grants cover most of the cost of medicaid. The 630 million dollar cut here means almost 380 million dollar annual loss to the state economy. Strong federal match has been an incentive 14 against cutting medicaid. Though Tennessee passed a plan this year to take some 300,000 people off the rolls, Amy Bluin with the Missouri Budget Project says Tennessee started with a much larger, more generous program. She says Missouri is pushing into new territory.

You have to question if we are really the kind of like the crash-test dummy 15 for the nation? Are we going to be standing 16 out as the show-me state for other states, or showing them what not to do?

Bluin predicts the cuts will cost Missouri thousands of jobs. Possibly among them, the home health aids that sustained 44-year old Irene Schivers.

They want us to die. We are a burden on society, so they don't care.

Schivers spends all day in an ancient mobile home she shares with two dogs, a yellowed computer and a collection of dolls. Cerebral 17 palsy has destroyed her coordination 18 and slurred 19 her speech. Under the new guidelines, she'll have to spend her income down to less than 500 dollars a month before medicaid kicks in. And then she'll have to pay more for doctor visits and drugs. She says she'll have to ration 20 food and get rid of the dogs, even the one trained to alert her before she has a seizure 21.

Some days, I get so depressed 22, I'm waiting to go, I'm just waiting to go.

As both sides seek the moral high ground in this debate, some leaders are formulating 23 plans to make further cuts. A commission will soon be formed with the mandate 24 to dismantle 25 medicaid here by June 30th, 2008.

For NPR News, I'm Frank Morris in Kansas City.

Details about Missouri's Medicaid problems are in NPR.org.