HEALTH CARE Republican proposal calls for recipients of Medicaid to pay more

Most of the savings in government spending will come from Medicaid.
WASHINGTON (AP) -- House Republicans are taking a cue from the nation's governors when it comes to reducing Medicaid.
Like the governors, they're proposing that states be allowed to charge people more when they receive care.
"Common sense reform will ensure that Medicaid can save and prolong millions more American lives for years to come," said Rep. Joe Barton, R-Texas. "If we succeed, we will make Medicaid better and poor people healthier. If not, the safety net will rot away."
Barton's committee, the Energy and Commerce Committee, is looking to reduce government spending by up to $14.7 billion over the next five years. Most of the savings are expected to come from Medicaid, which provides health care for about 53 million poor and disabled people.
Higher co-payments
The House legislation would give states the option of charging higher co-payments. States, within limits, can require some beneficiaries to share in the costs of their health care. Typically, the current co-payment ranges from 50 cents to $3.
The House bill would raise that gradually to a maximum of $5 per service in 2008. Afterward, co-payment increases would match those in health care inflation.
All told, the cost of co-payments may not exceed 5 percent of a family's income.
Barton has said people will make wiser health care decisions if more money is coming out of their own pockets. But some advocacy groups said that higher fees will prevent some poor people from getting health care altogether, or at least until an illness reaches the critical stage.
The committee did not release an estimate on how much savings the bill would produce.
Senate legislation
Medicaid legislation being considered in the Senate does not include higher co-payments. The Senate Finance Committee planned to consider a bill today that would trim Medicaid and Medicare spending by about $10 billion. Most of the Medicaid savings would come from reducing payments to pharmacies for filling prescriptions.
The House bill also would reduce payments to pharmacists.
Either bill could drive community pharmacists out of the Medicaid business, said Charlie Sewell, vice president of government affairs for the National Community Pharmacists Association.
Under both, the lion's share of Medicaid savings comes out of pharmacists' pockets, he said, adding that the House bill was more palatable than the Senate version.
Barton's proposal also calls for more restrictions on when people can transfer assets before becoming eligible for Medicaid coverage for nursing home care. The changes are designed to ensure people don't impoverish themselves so that taxpayers will pay their nursing home care.