But it was the Bush administration's recent proposal to cut $60 billion - about 2 percent - from the 10-year projected federal Medicaid budget that prodded Woolford to fight back. Woolford, who relies on Medicaid to treat her degenerative disk disease and arthritis, is parlaying her post as president of a senior housing council to mobilize a letter-writing campaign, pleading with Utah members of Congress to reject the cuts.
"If I were born with a silver spoon in my mouth, I wouldn't be taking money from the poor," Woolford said. "What Bush is doing hurts the little people, children and seniors more than anyone else. It makes me angry, very angry."
Medicaid is one of the most convoluted and critical government programs, making it possible for about 250,000 needy Utahns to get medical care. But the federal government and states are struggling to sustain the program as health care costs and the number of uninsured explode.
State Health Department Director David Sundwall says Utah is in "an enviable position" compared to other states that are looking to chop enrollment in half.
"We have a pretty good track record for managing Medicaid and getting the most from our dollars," said Sundwall, citing the Legislature's recent restoration of dental and vision benefits and extension of coverage to 12,000 more uninsured children. Still, says Sundwall, "We will probably have to figure out how to live with a smaller budget."
This year, the state will spend more than $1.4 billion on Medicaid, with Uncle Sam picking up more than $1 billion of that tab. If federal matching funds are significantly reduced for future budgets, states will face painful policy decisions - including whether to increase their own spending, cut enrollees or eliminate or cap benefits.
Medicaid enrollment rose 52 percent from 2001 to 2005. The vast majority - 85 percent - of recipients are children and families. But the elderly and disabled who comprise 14 percent are responsible for 62 percent of the costs. And the fastest growing expense is drugs.
For this reason, Sundwall is exploring setting up a bulk prescription purchasing agreement with other states and a preferred drug list to encourage the use of generic medicines.
In a published statement of principles, Sundwall supports the Bush administration's efforts to "reshape and modernize" Medicaid, including giving states more leeway to custom-fit benefit packages and encourage workers and their employers to shoulder some of the burden.
Low-income advocates interpret that as slashing benefits and stress Utah's experiments on that front - the Primary Care Network (PCN) and Covered At Work - are the wrong solutions.
PCN was designed to insure Utahns who earn too much to qualify for Medicaid but can't afford private insurance. It covers preventative doctor's visits and was subsidized by cutting vision and dental services from other Medicaid recipients.
Judi Hilman, health policy analyst for Utah Issues, says while PCN may be valuable for younger, healthier Utahns, the typical Medicaid recipient has unusual health care needs.
Under Covered at Work, the state pays workers $50 a month to help pay the premiums charged by their employer's insurance plan. It was funded for 6,000 workers, but only 72 slots have been filled.
Bush's new Health and Human Services Secretary Mike Leavitt has pledged not to scale back benefits for the most needy. But he has targeted the two-thirds of recipients considered "optional."
Hilman says that leaves 6,000 to 7,000 aged, blind, disabled Utahns and those with catastrophic illnesses as most vulnerable.
"Three years ago when we had our big fiscal crisis, that group was cut. We got them back. But we're expecting we'll have to defend them again," says Hilman.
She believes the bubble of baby boomers approaching retirement age and who need Medicaid to supplement gaps in Medicare coverage are also vulnerable.
Says Woolford, "We've got to help each other, organize and let officials know how we feel. If we don't, who will?"
kstewart@sltrib.com
