Recent advancements in medicine and life-saving technology don't do much to help sick patients who can't take advantage of them because of cash-strapped state health care programs, resulting in "first-rate medicine and a third-rate health care system," a comprehensive new study found.
The year-long study of government-funded health care in the 50 states was done by Governing magazine with support from The Pew Charitable Trusts, which separately also funds Stateline.org.
"Clearly, there is a health care crisis in America, but it is in no way a medical crisis. It is a fiscal crisis," said the report titled: "A Case of Neglect: Why Health Care Is Getting Worse, Even Though Medicine Is Getting Better."
Governing focused on six major areas of health care funded by state dollars: mental health, public health, long-term care, children's care, prescription drugs and the growing number of uninsured. Across the board, the study found improvements in modern medicine, but a decline in access to it for needy populations that depend on the safety net of public health programs.
"Over and over again it became clear that the dollars involved are huge and that the essential problem here is a fiscal one. If there were endless dollars available, there would be no health care problem in this country," Richard Greene, one of the study's three authors, told Stateline.org in an interview.
Medicaid is at the heart of problem, the report said. The state-federal health insurance program for nearly 50 million poor and disabled Americans is the second biggest item in state budgets and accounts for 20 percent of state spending. In 2002, state and federal Medicaid expenditures came to $258 billion, accounting for about 17 percent of all hospital care, 17 percent of prescription drug spending and nearly half of all nursing home care.
"A lot more attention should be focused on (Medicaid)," said Katherine Barrett, another of the study's authors. "It's just such a huge amount of money and such a huge amount of each state budget, and the states really are stuck."
States recently faced their biggest budget shortfalls in decades even as health care costs have soared. In an effort to slow Medicaid growth, which dropped to 9.3 percent in 2003 from 12.8 percent in 2002, all 50 states over the past two years have taken steps to control Medicaid costs by reducing or freezing Medicaid provider payments, cutting benefits such as vision or dental care or restricting the prescription drugs Medicaid patients can receive.
Greene said the big cuts that states are making to health care programs might make short-term financial sense but can hurt people and don't make long-term sense.
The study's basic findings were:
Governing looked at health care in all 50 states but did not rank or grade each state's performance. Instead, it highlighted "success stories" and "trouble spots." Several states appear in both categories.
Colorado, for example, was targeted for stripping all state funding $500,000 from its childhood immunization program. Colorado still receives federal dollars for childhood vaccines, but it has the worst immunization rate for children in the country, the study pointed out.
Cindy Parmenter, spokeswoman for the Colorado Department of Public Health and Environment, told Stateline.org that every state agency endured budget cuts. "Certainly, those kinds of cuts are very difficult to make and they're very difficult decisions. But they're decisions that have to be made by states that must operate on a balanced budget," she said.
Parmenter said Gov. Bill Owens (R) has allocated $500,000 in one-time federal money to the program this budget cycle and is hoping the legislature will come up with some extra state dollars. "We're really working hard now to reinstate money to get that program back in line," she said.
Governing singled out other states as needing improvement:
Among the success stories:
The report is published in the February issue of Governing magazine.