Home / Doctors, HHS Clash Over Need For Higher Co-Payments For Medicaid

Doctors, HHS Clash Over Need For Higher Co-Payments For Medicaid

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A Bush Administration proposal to hike Medicaid co-payments for adults and introduce co-payments for children has drawn fire from doctors.

The debate came at an Aug. 17 meeting of the Medicaid Reform Commission, 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.

Under current law, adults pay $3 co-payments. Co-payments are not allowed for children under 18. The administration is proposing $5 co-payments for adults, and $3 co-payments for children.

Under the proposal, the Congressional Budget Office estimates, Medicaid recipients would pay $4 billion in additional charges over the next five years. But according to an Aug. 18 story in the New York Times, Dennis G. Smith, a top federal Medicaid official, reminded his fellow panel members that this 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.


Democrats have been leery of the commission, saying it would simply ratify budget cuts proposed by President Bush. Shortly after it was created, Senate Minority Leader Harry Read (D-NV) and House Minority Leader Nancy Pelosi (D-CA) declined the invitation to appoint four non-voting members to the commission, which it said was stacked with as many as 34 voting and non-voting members appointed by Republicans.

“We fundamentally disagree with the premise that this Commission should make recommendations on how to cut Medicaid outlays by $10 billion by September 1. While we need to reduce the deficit, we should not make cuts affecting the most vulnerable Americans in order to finance more tax cuts for the wealthy,” Reid and Pelosi wrote in a May 26 letter to HHS Secretary Michael Levitt.

But the panel made clear yesterday that it would not rubber-stamp the Bush Administration proposal.

“If we raise the co-payment, some people will not get the care they need. These are real people,” the Times quoted commission member Dr. John C. Nelson, a former president of the American Medical Association.

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.

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.”


The commission was established in May with the charge of saving $10 billion over five years. It will decide on the administration’s proposed co-payment increase in a report to be submitted to Levitt on Sept. 1.


This article first appeared at Journalists Against Bush’s B.S.

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About David R. Mark

  • RedTard

    $3 copays are already ridiculously low. I think that raising them is a step in the right direction, especially for critical resources such as emergency room care.

    You probably have no idea how often ER’s are abused by poor folks because they know that they’re not going to have to pay for it. People who pay for their own healthcare will only use critical resources in a true emergecy not every time their kid gets a runny nose.