Governors, who’ve been told by President Bush to go home and stare at their own budget spreadsheets, ought to take a look at the president’s spending plans and start screaming bloody murder! Because it seems that many states – foreign states – are going to get the dollars they so badly need to save so many social safety net programs.
Consider some recent headlines: “Governors, Hurting Financially, Ask Washington for Assistance” (New York Times, 2/23/03), “President Bush Rejects Governor’s Request for Additional Medicaid, Homeland Security Funds”(California Healthline, 2/25/03), “Bush Proposes Major Changes in Medicare and Medicaid” (New York Times, 2/24/03), “Iraq War Cost Could Soar, Pentagon Says” (Los Angeles Times, 2/26/03).
The Pentagon now estimates the cost of the Iraq War and occupation for 6 months to cost $85 billion. But when the bribes to Turkey are added on to allow American troops on its soil –$6 to10 billion in grants and up to $20 to 24 billion in long-term aid loans — that could top the $100 billion mark or “twice the war costs cited just last month by Defense Secretary Donald H. Rumsfeld and an amount that the White House dismissed as outlandish last fall.” (LA Times, 2/26/03).
Surprising the Bush gang, however, the Turkish Parliament, albeit narrowly, decided against taking Bush’s money and allowing US combat troops in for now. It would seem democracy is stronger there than here, where our congress has not voted on the war with Iraq.
At home the Govs are facing the worst fiscal crisis since WWII. The National Governors Association asked Bush for new federal financial assistance for state Medicaid programs. Medicaid, which covers some 45 million people, has grown in recent years due to the number of uninsured rising in a soft economy, high insurance premiums, and private insurance out of pocket costs.
The Govs asked for more federal funding. They were in agreement that the federal government should cover the cost of long-term care for low-income seniors and disabled who qualify for Medicaid and Medicare – and for homeland security to secure our still vulnerable cities, towns and ports.
Bush, however, flatly turned them down stating there is no more money for anything. Bush told them “the federal government has fiscal problems of its own and could not bail out the states.” (New York Times, 2/25/03)
By any measure, as I will get to shortly, the Govs request was so little to ask for.
But first, does anyone remember that on the campaign trail Bush had said he would never create deficits?
In the first quarter of 2000 when he became president, the budget was in surplus to the tune of 2.3 % of GDP. The Congressional Budget Office forecast that the 2003 deficit will be $199 billion and next year’s $145. Still yet these estimates do not take account of new tax cuts, new spending nor war in Iraq, nor rebuilding Afghanistan’s or Iraq’s infrastructure after it, too, is bombed back to the stone age. Now Bush is asking Congress to pass another windfall for the rich, a $674 billion tax cut package (over 10 years).
It is not that a deficit in and of itself is detrimental but as the Reagan era economic advisor David Stockman later revealed, deficits could be used as a prelude to and pretext for cutting back public social services.
Poor people are, in fact, being punched left and right as governors close their $50 billion budget gap by cutting social services and programs such as education, transportation, health and human services. In many states Govs are eliminating or cutting back parts of the Medicaid program labeled “optional” such as dental visits, durable medical equipment, and mental health services.
Massachusetts Medicaid, for instance, has allowed a buy in for working disabled persons called Masshealth. Currently it is experiencing unprecedented budget cuts. Those on the program have lost dental benefits and the prescription co-pay went from fifty cents to two dollars. Jan 1, 2003 eyeglasses, dentures, and prosthesis were eliminated from coverage. (The reason a buy in is needed is because insurers create waiting periods for those with pre-existing conditions and jack up premiums to unaffordable prices if they will write significantly disabled person a policy at all. Being able to get public health care takes the load off the employers who are usually not keen to hire disabled persons.)
Still over 66% of Medicaid spending on disabled people is “optional” – not because the services are not needed but because the states are not required to pay for it.
States have been reducing drug expenditures and payments to Medicaid providers making the difficult job of finding a doctor who will take Medicaid even harder. County health care clinics have closed. Los Angeles, for example has closed 14 and looking to close major hospitals as well.
Tax cuts and future war bills will increasingly become a local problem paid by those needing social safety net services – elderly, disabled persons, poor children, the growing numbers of unemployed, and the working poor who do not have health insurance from their employers.
Bush has not, however, turned down billions to client states. His denial of money to the Govs and ultimately the people who live in their states is rather hard to swallow when Economic Support Fund (ESF) allocations are provided on a grant basis to foreign nations and travel across the oceans for a variety of economic purposes, like infrastructure and development projects. (This is on top of other types of aid like the $3 billion Israel gets in direct payments from the US; that is about $1,000 for every man, woman, and child there.)
According to the Arms Trade Resource Center (Oct. 2002) Bush’s 2003 ESF budget request is $2.29 billion. The top recipients include: $600 million for Israel, $615 million for Egypt, $200 million for Pakistan, $60 million for Indonesia, and $25 million for India.
Then there are the Foreign Military Financing (FMF) grants and loans that must be used by the recipient nation to purchase U.S. defense-related items. International Military Education and Training (IMET) grants are given to foreign governments to pay for professional education in military management and technical training on U.S. weapons systems.
The 2003 FMF budget request of $4.107 billion includes $2.1 billion for Israel, $1.3 billion for Egypt, $20 million for the Philippines, $50 million for Pakistan, $50 million for India, and $98 million for Colombia.
This year’s $80 million IMET budget request represents a 27.5% increase over 2001. Top recipients include major allies in the war: India, Pakistan, Uzbekistan, Georgia, Philippines, Jordan, Oman, and Yemen.
Not enough? The Arms Trade Resource Center reminds us that the following funds were doled out as part of the emergency supplemental bills:
$600 million in ESF for Pakistan; $40.5 million in economic and law enforcement assistance for Uzbekistan; $45 million in FMF for Turkey and Uzbekistan; $45.5 in Non-proliferation Anti-terrorism De-mining and Related programs; $42.2 million for training and equipment for border security forces in Uzbekistan, Tajikistan, Turkmenistan, Turkey, Kyrgyzstan, Azerbaijan, and Kazakhstan; $108 million for a variety of counter-terrorism training programs and de-mining in Afghanistan. The FY 2002 Supplemental included $665 million for ESF, $387 million for FMF, $110 million for Assistance for Independent States of the former Soviet Union, and $88 million for Non-Proliferation, Anti-terrorism, De-mining, and Related programs ($12 million of which will go to Indonesia).
The Bush administration has stepped up military assistance to allies old and new. The State Department and International Affairs budget request for 2003 was $25.4 billion, up $1.4 billion from last year. While the numbers pale in comparison to the Pentagon budget that consumes over 50% of discretionary spending, assistance has increased substantially.
The French press recently quoted two different diplomats from the US State Department highlighting that the United States is giving benefits to Colombia — and other non-members of the Security Council to get U.N. votes. (Associated Press and USA Today)
In its report “Coalition of the Willing or Coalition of the Coerced” the Institute for Policy Studies shows that the US used military, economic and political leverage to influence allies to support the Iraq war against the will of their people.
Bush has been using American clout and dollars to busily buy off nations to clear the political tracks for invasion. Restrictions on military aid and arms transfers to regimes involved in human rights abuses, support for terrorism, or nuclear proliferation have already been lifted for a number of countries in exchange for their support reports the Arms Trade Resource Center.
As for the administration’s plan to reinvent Medicaid, that is nothing short of a frontal assault on the Medicaid Program. Secretary of Health and Human Services Thomas Thompson, for instance, cites the “success” of welfare reform that ended poor women’s’ entitlement to aid as a good precedent, stating that his extreme plan to revamp Medicaid would end that entitlement too.
Instead of giving US states more aid in a time of crisis, the Bush administration would “modernize” Medicaid giving states the “flexibility” to cut Medicaid eligibility, benefits, and provider reimbursements; set different eligibility criteria in different parts of a state; and to waive quality and due process appeals rights. States could require that patients share more of the cost of services by adding co-payments or deductibles. They could limit the number of visits to hospital emergency rooms. They could cap enrollment in the program and initiate co-payments to services.
In short states could shave off care.
State “flexibility” is reminiscent of Gingrich’s mid-1990’s attempt to block grant Medicaid and end the automatic guarantee of coverage for the poor but Clinton was in the White House and rightly vetoed the effort.
Thompson’s version of Medicaid would be optional for states, the carrot being a pot of money upfront to choose it. Bush proposes giving states that opt for his plan an extra $3.25 billion in 2004. Those who do not go for the pot with strings attached get federal matching funds the states already receive. The upfront infusion would come with the price tag of having to pay it back in the last three years of the ten-year plan.
Families USA warns of Thompson’s plan, “federal spending on Medicaid will be capped regardless of states’ needs in ways that will hurt millions of the most vulnerable beneficiaries.”
The vulnerable include, amongst others, over 1.5 million disabled persons who are now considered Medicaid “optional” beneficiaries. These are persons who have incomes above SSI eligibility levels, those eligible for Medicaid through home and community based waivers, some working disabled persons, and the medically needy. They would not likely be able to get private insurance due to their chronic health care needs – and if they could adequate coverage would be prohibitively expensive.
Remember that the business class was instrumental in designing the “welfare state” of which Medicaid is a part. The US health care system fostered by the dominant class and run by the insurance industry only provides the miniscule Medicaid program (though they complain about how much it has grown and how much it costs) to stave off a transformation that would provide a universal health care system – disability sensitive – to every person in the nation.
The fact that the poor must fight to retain inadequate health care at every fiscal crisis and 41 million people go without insurance at all is because health care is not a human right under bourgeois laws that support our laissez faire national tendencies. The fear that health care will not be available is part of the system — to keep us in our place.
As for the Bush Iraq agenda, one writer described him as an “under-qualified matriculate.” Bush and his administration are looking more like fiscally irresponsible cash-doling, wheel-greasing, warmongers with high hopes of out-doing Bush’s daddy to become the Middle East conquerors at the people’s and ultimately, the country’s expense.
Yale Professor William D. Nordhaus, using the metaphor of war as a giant roll of the dice says, “we might say that the US could end up paying the “low” costs of around $120 billion if the dice come up favorably. If some dice come up unfavorably, the costs would lie between the low and the high cases. However, if the US has a string of bad luck or misjudgments during or after the war, the outcome, while less likely, could reach the $1.6 trillion of the upper estimate.” Even this may be an underestimate, he warns under some circumstances.
With a deficit estimated at between $26 billion and $35 billion — more than the GDP of some nations — does California qualify as a needy client state?
California is facing a 7% across-the-board cut that will leave thousands without access to health care. Nationally millions people could lose their Medicaid under Thompson’s plan. People will die.
Democrats have proposed that $136 billion in federal dollars be given to the states to help close their deficits stating that the Bush stimulus plan “has ignored the states altogether.” ( California Healthline, 2/26/03) About $30 billion of that would go for expenses like Medicaid. That pales in comparison to what Bush & Co. is doling out all over the world.
The Govs showed backbone and rejected the Thompson “modernize” Medicaid plan. Perhaps the Govs should deal their own hand and oppose the war on Iraq. Then they could hold out for some Bush bribes to aid their hardest hit citizenry and infrastructures. The headline could read “Govs to Bush: Call the Dollars Home Before It’s Too Late” or something like that.
— Marta Russell can be reached at firstname.lastname@example.org http://www.disweb.org