As Republican leaders in Congress move to trim billions of dollars from the Medicaid health program, they are simultaneously intervening to save the life of possibly the highest-profile Medicaid patient: Terri Schiavo.
The Schiavo case may put a human face on the problem of rising medical costs, both at the state and federal levels. In Florida, where Gov. Jeb Bush (R) is pushing a dramatic restructuring of the Medicaid program, the cost of Schiavo's care has become political fodder. In Washington, where a fight over Medicaid spending threatens to scuttle the 2006 budget plan, the role of the program in preserving Schiavo's life is beginning to receive attention.
Michael Schiavo fought to end his wife's feeding.
"At every opportunity, [House Majority Leader] Tom DeLay has sanctimoniously proclaimed his concern for the well-being of Terri Schiavo, saying he is only trying to ensure she has the chance 'we all deserve,' " the liberal Center for American Progress said in a statement Monday, echoing complaints of Democratic lawmakers and medical ethicists. "Just last week, DeLay marshaled a budget resolution through the House of Representatives that would cut funding for Medicaid by at least $15 billion, threatening the quality of care for people like Terri Schiavo."
DeLay spokesman Dan Allen fired back: "The fact that they're tying a life issue to the budget process shows just how disconnected Democrats are to reality."
Lawyers for Schiavo's husband and guardian, Michael Schiavo, have said repeatedly that Medicaid finances her drug costs, but it is not entirely clear how dependent Schiavo's caregivers are on the joint federal-state health insurance program for the poor and disabled. In 1993, Michael Schiavo received a medical malpractice judgment of more than $750,000 in his wife's name, according to a report by her court-appointed guardian ad litem. The money was placed in a trust fund administered by an independent trustee for Schiavo's care.
Michael Schiavo's lawyers have said that $40,000 to $50,000 remains. Patient care at the Florida hospice where Schiavo lives averages about $80,000 a year, but the hospice now pays for much of her care. For two years, Medicaid has covered other medical costs, including prescription drugs, the attorneys have said in published reports.
Medicaid's share of Schiavo's care "is a big chunk," said Rep. Debbie Wasserman Schultz (D-Fla.), who until this year was involved in the case as a state senator. "Governor Bush and President Bush are both professing deep concern for the rights of one disabled person, yet their rhetoric doesn't match their actions," she said.
Florida's Medicaid program is expected to cost about $14 billion this year, with the state covering 41 percent of the budget, said Jonathan Burns, spokesman for the state Agency for Health Care Administration. For every $1 Florida spends on Medicaid, it receives about $1.44 from the federal government in matching funds.
The governor has proposed limiting Medicaid spending and in essence giving each beneficiary a voucher to shop for a health plan. Advocates for the poor and disabled contend the approach would leave the most vulnerable without adequate coverage.
If it passes, "I guess Mrs. Schiavo or someone on her staff would have to find a network that will take care of her for the amount of money" the state provides, said Andrew Schneider, a Washington-based health care consultant who specializes in Medicaid.
In Washington, House Republicans approved a budget resolution for 2006 last week that would order $15 billion to $20 billion in Medicaid savings over the next five years. But when Senate leaders tried to follow suit with a budget that trimmed $14 billion from Medicaid, 52 senators balked. The Senate and House differences over the program may jeopardize lawmakers' ability to craft a budget this year, thus threatening all of President Bush's cost-cutting efforts.
Ron Pollack, executive director of the health care advocacy group Families USA, denounced the "two ironies" of the situation.
"At the same time congressional leaders were trying to keep Terri Schiavo alive, they voted to cut the Medicaid program that keeps many millions of people alive," he said in an interview. Jeb Bush, meanwhile, "is grandstanding about Terri Schiavo at the same time he is pushing real hard to place a limit on the dollars available for people's care, including care like Terri Schiavo is receiving," he said.
Republicans say such rhetoric further complicates the unavoidable task of controlling Medicaid's growth. "Too many people would rather resort to scare tactics than have a constructive conversation about ways to fix the nation's long-term budget crisis," said Gayle Osterberg, spokeswoman for the Senate Budget Committee.
The cost of care in cases such as Schiavo's has vexed governments for years. In 1999, then-Texas Gov. George W. Bush signed a law establishing procedures for hospitals and physicians to withhold life-sustaining care from patients with conditions deemed hopeless, even over relatives' protests. The legislation affords a family 10 days' notice to find another facility. Last week, Texas Children's Hospital in Houston invoked the law to remove a 6-month-old boy from his breathing tube against his mother's wishes.
It was a Republican, Rep. Steve King (Iowa), who first brought the issue of Schiavo's Medicaid support to Washington. On the House floor Sunday, he blasted Woodside Hospice, where Schiavo lives, for allegedly bilking Medicaid, citing a Government Accountability Office audit that he said ordered the company to repay $14.8 million in "inappropriately collected" fees.
The Hospice of the Florida Suncoast Inc., which operates Woodside, was cited in 1996 for nearly $15 million in payments for ineligible beneficiaries and patients who may not have been terminally ill. But the issue was Medicare charges, not Medicaid, and the investigator was the Department of Health and Human Services' inspector general.
Mike Bell, a company spokesman, said the not-for-profit did not have to repay any money. The investigation, which involved several hospice care providers, "led to clarification and directions going forward," he said.
But King was making a point other Republicans have argued: that waste and fraud can be wrung out of the Medicaid system without sacrificing patient care -- but only if Congress gives states more flexibility.
Said Osterberg: "The reason for the budget seeking . . . administrative modifications is to ensure the program is more efficient and financially sound moving forward, so that beneficiaries don't have to be kicked off down the road."