Thursday, June 18, 1998

Home health care takes a big blow

By Molly Ivins

AUSTIN -- Bad governance is, in its own way, an interesting study -- not unlike those monsters in sci-fi films that start as small blobs and then turn into something that eats Chicago. You start with just a li'l ol' bill to deregulate the savings and loans, and before you know it, it's a screaming horror that costs taxpayers $500 billion.

The art of writing law so it does precisely what it is supposed to, and not anything else, has always been hard to come by. The careful, painstaking, legislative craftsmanship that marked the tenure of, say, Bob Eckhardt in Congress is starting to look like a lost skill.

The law of unintended consequences may be unavoidable, but when you see legislation deliberately deformed for some cheap political purpose -- not just the OPO (obvious payoff) to big campaign contributors but some evanescent partisan advantage -- it is ... discouraging.

Last summer, in its haste to pass the Balanced Budget Act, Congress dramatically changed the reimbursement system used to compensate home health agencies for the services and care they provide for Medicare patients. The political problem was that the Republicans could not afford to be seen cutting Medicare, this scenario having been an effective ploy for the D's in the previous election.

Rather than "cut Medicare," the act robbed Peter to pay Paul by shifting costs from Medicare home health to hospital and nursing home costs under Medicare and Medicaid. The Department of Human Services went on to implement the policy retroactively, severely limiting Medicare reimbursements for home health care.

The effect was to enable Congress to claim it had not "reduced benefits" under Medicare by making the home health-care agencies the messenger with the bad news. They didn't "cut benefits" -- they just stopped payment. Cute, eh? In fairness to the R's, nobody knew just how drastic the consequences would be.

Now, according to the Texas Association for Home Care, the result of capping payments for home care and shoving old folks into far more expensive hospitals and nursing homes instead is an additional $81 million per year in state taxes in Texas alone.

Consider the sheer stupidity of this maneuver. If you know anything about frail seniors, you know they are healthier and happier if they can remain in their own homes. When they reach the point at which they just need a little bit of help to do so, in comes a home health-care nurse, who helps and is on his way at minimal cost to the taxpayer. This is far healthier and more sensible and humane -- and cheaper -- than putting the senior who just needs a little help into a nursing home that costs the Earth, uproots the senior and frequently sends him or her into a decline.

According to TAHC officials, the "Interim Payment System" instituted by the Department of Health and Human Services reduces reimbursements paid to home health-care agencies by an average of 61 percent. Oops. Further, reductions are based on the home health costs for 1994, without regard to current costs or patient loads.

Sara Speights, director of government relations for TAHC, said: "The IPS is a farce. It costs taxpayers more money, forces honest, hard-working agencies to close their doors, and leaves the sickest, most frail home-care patients with nowhere to run for home health care. The IPS must be revoked."

The Center for Health Policy Research of George Washington University reached similar conclusions in a study released in April: The new policy deprives the frailest Medicare beneficiaries of access to home health-care services and will push the most efficient home health-care agencies out of the Medicare program. Just to complete the folly, studies show while old folks remain in their homes, their families continue to be actively involved in their care; when they go to nursing homes, family involvement drops dramatically.

Think we could get the Christian right to take this issue up as a family-values deal? You must admit it would be a lot more useful than having them spend their time working people into a lather over the dim prospect of gay marriage.

Just a footnote on the hideous killing of a black man in Jasper County, allegedly by three white racists: In 1993, state Sen. Rodney Ellis passed a hate-crimes bill that provides for increased punishment for convicted criminals if it is proved the crime was motivated by bias or prejudice. The problem is, the law is almost certainly unconstitutional because of its vague wording.

So last session, Ellis tried to meet the constitutional tests by putting precise language into the bill. It went nowhere. It was particularly opposed by those who didn't want to be seen helping "queers" in any way. What a charming Lege we have.

For you death penalty fans, prosecutors in Jasper wouldn't be sweating to prove kidnapping if we had an effective hate-crimes law in place. Ellis promises to try again next session. Meantime, hate crimes in Texas were up again by 7.7 percent in 1996, the most recent year for which stats are available, according to the Texas Department of Public Safety.

Creators Syndicate, Inc.