Buster of State Budgets

ONE of Washington's touchy stories is the impact Medicaid mandates pushed through Congress by Rep. Henry Waxman (D) of California, chairman of the House subcommittee on Health and the Environment, have on severe state deficits.Congressman Waxman has used the annual reconciliation bill to force costly new Medicaid programs on the states for the last four years. The governors have singled out these "Waxman mandates" as one reason so many of them have had to raise taxes, slash spending, and even "furlough" employees to wipe out the deficits 31 of the 50 states faced this year. In Washington for their winter meetings last February, they complained to Waxman. Waxman's response was summed up by South Carolina Gov. Carroll Campbell (R), who accused him of being "almost cavalier in his attitude toward the states. Like, 'It's their problem how they pay for it. The governors have sound reasons for their concern over the "Waxman mandates." National Governors Association (NGA) figures show Medicaid costs, as a share of states' budgets, up more than 50 percent, from 9 to 14 percent - and still rising. In raw numbers, the states' Medicaid costs spiraled from $11.2 billion in 1980 to $31.6 billion in 1991. Part of the increase is due to inflation in health-care costs. Waxman is part of what his colleague Rep. Bill Richardson (D) of New Mexico describes as "the pure liberal wing of the party on social issues. He embodies the tax and spend wing of the party." That wing of the Democratic Party expands access to social programs but shows little interest in controlling costs. Waxman is well-liked by his celebrity constituents. The Almanac of American Politics says his Hollywood-based district "embraces most of the heart of the entertainment business ... records and television as well as movies." Contributors to Waxman's political action committee include stars like Ed Asner, Jack Klugman, Jane Fonda, Norman Lear, and Barbara Walters. Waxman used his liberal credentials and a war chest filled by his rich patrons to jump the seniority line in 1979 and win a powerful chairmanship by pushing aside a respected Southern moderate with more seniority. WAXMAN'S biggest success has been to extend access to Medicaid - once limited to recipients of Aid to Families of Dependent Children - to low-income women and children not on AFDC. Medicaid passes half the bill to the states. In 1986 Waxman won the support of the states for a new "optional" plan that let governors address the rising infant-mortality rate by designing special Medicaid programs for non-welfare women and children with incomes up to the poverty level. The governors went along, NGA's Ann Danelski says, because "we thought the states would be able to provide for more women and children under the plan." Next, in 1987 he dropped the "optional" limit and mandated coverage for any eligible child under the age of seven on Oct. 1, 1989. In 1990, he extended coverage for those children until they are 18. He hiked the income ceiling to 185 percent of the poverty level, increasing states' costs and insuring yearly increases for 11 years. Waxman shifted to mandates after the Democrats recaptured the Senate in 1986, ending the power of a GOP-run Senate to insist on optional programs. To limit Medicare cuts in the '80s, Waxman helped shift costs to Medicaid and, thus, the states. Medicaid must now pay the monthly "buy ins" to Medicare programs for low-income Social Security recipients and pick up a big share of nursing home costs. Waxman's use of the reconciliation bill has kept his success out of the public eye. Reconciliation is the ultimate insider's game on Capitol Hill. In one bill Congress can change laws, force spending cuts, set spending limits, and, thanks to Waxman, slap new Medicaid mandates on the states. The reconciliation bill enabled Waxman to shield his mandates from bloody floor debates and avoid an up-or-down vote on specific mandates. The new mandates get lost in the fine print. Waxman has been known to shout and pound the table to get his way in conferences on the reconciliation bill. While it's being put together, he uses closed-door party caucuses and whip meetings to warn fellow Democrats against selling out women, children, and senior citizens. Few lawmakers want to be labeled anti-women and children. Once his mandates are in a bill, Waxman has it made because there is strong institutional pressure in both bodies to act quickly on reconciliation bills. Waxman has his critics. One is Bill Hoagland, the top GOP staff member for the Senate Budget Committee, who says Waxman has "abused the reconciliation process tremendously. He's become the master of using the technical aspects of budget procedures to create the opportunity for starting new programs." Waxman and his staff have not responded to repeated requests by this writer over a period of months for an interview on the mandates and their effect. Waxman can count one more success. The pressure he's put on state budgets has brought the nation's governors to the table to talk about fashioning a new national health-care plan in hopes of cutting costs. Once there, they found businessmen, labor union leaders, and physicians ready to talk for the same reason. That, Governor Campbell claims, has been Waxman's goal all along. A major obstacle stands in the way of a new plan that wraps Medicare and Medicaid into a single new national health-care system and relieves the states of a fiscal burden. That is the runaway cost of health care. Waxman has contributed to that problem by ignoring the cost factor.