be changed?

President Bush has proposed cutting $60 billion - about 2 percent - from the projected federal Medicaid spending over the next decade. Among his proposals:

* Reduce wasteful spending.

* Cut costs. Proposals include closing loopholes that allow seniors to give away personal assets in order to qualify; crack down on creative accounting tricks states use to get more federal matching funds; ending Medicaid's overpayment for prescription drugs.

* Give states more flexibility to reduce benefits for the estimated one-third of recipients considered optional. This category generally includes children, adults and seniors with incomes above 133 percent of the federal poverty guidelines.

* Offer tax incentives to help the poor purchase private insurance; encourage small businesses to pool together to qualify for cheaper insurance coverage; promote wider use of health savings accounts.

* The nation's governors have suggested capping benefits or increasing co-payments.

Critics caution against cuts

Advocates criticize Bush's plan as balancing the budget on the backs of the nation's neediest people. Among their concerns:

* Without the safety net of Medicaid, more people will forgo preventive doctor visits, resulting in more high-cost trips to emergency rooms. This will financially burden hospitals, which will pass costs onto consumers or write off more charity care, leading to a depletion in state tax revenue.

* If granted more flexibility, states will reduce benefits, cut off certain populations or impose higher co-payments and premiums - leading to higher numbers of uninsured Americans.

* Medicaid cuts will hurt Utah's economy. One University of Utah study found the program drew a $619 million federal match in 2001, supporting about 17,000 jobs and more than $453 million in earnings.

* Medicaid costs per person are lower than those for private insurance, advocates note. Advocates call for greater reform of the health care system.

Would you like to comment on this primer or share how you rely on Medicaid? E-mail reporter Kirsten Stewart at kstewart@sltrib.com