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Tuesday, November 15, 2005 |
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When one of Lincoln County Pharmacy's customers picked up his prescription Wednesday, an employee met him at the curb with his "cowboys" – his term for pills – in hand.
It's difficult for the customer, who has a disability, to walk through the Davenport drugstore to get them, pharmacist and owner Tom Paul explained. Meeting him at the door is just part of the personal attention that a local, independent pharmacy can offer.
Handmade milkshakes and sour phosphate drinks served at a counter are some others.
But critics of a bill up for a vote in Congress today say Republican plans to reduce the nation's deficit threaten the medical community, from small pharmacies like Paul's to large hospitals like Deaconess Medical Center. The House of Representatives is considering a deficit-reduction package that would cut about $10 billion from Medicaid and $45 billion more from other programs, including student loan subsidies and food stamps. It's attempting to reconcile its plan with a similar, although less controversial, bill the Senate passed last week.
"It will be the poor and disadvantaged that take the biggest hits on this," Paul said.
Inland Northwest Republican leaders, however, say the legislation is a necessary step Congress periodically must take to reduce the deficit.
"Those savings are only 'cuts' in the same sense that a more efficient car that gets better gas mileage 'cuts' the use of gas," Otter wrote in an e-mail response to a reporter's inquiry. "The goal is increasing efficiency, enabling states to be more innovative and flexible in their delivery of services, and treating a growing number of patients more effectively."
But local business and health leaders warned the legislation will hurt medical care and the economy. The sick will seek treatment somewhere – likely in costly emergency rooms, said auto dealership owner and Empire Health Services board chairman Chris Marr.
"If we take a little bit longer-term view of that we will see that the costs overall are greater to society and certainly to employers," he said. "We have to avoid the temptation that we're solving everything by merely transferring the costs to the backs of the insured."
The Working for Health Coalition, a group of Washington state doctors, hospitals, unions and other medical organizations, estimates that cutting $10 billion from Medicaid will mean more premature deaths and a $380 million increase in costs to people with insurance in Washington. When their care is covered, poor patients are less likely to have serious, expensive conditions and employers are less likely to bear the cost of absent or ill workers.
In Spokane County, the package would eliminate 50 jobs and strip $5.5 million from the economy, the coalition says.
The National Community Pharmacists Association claims the package disproportionately affects independent pharmacies, which will lose money each time they fill a prescription for a Medicaid customer. Nationwide, that will force more than 40 percent of those pharmacies to close, it estimates.
To survive, Paul said Lincoln County Pharmacy likely would stop filling Medicaid customers' prescriptions, which account for 25 percent of his revenues. While that decision might lead to the demise of Paul's 25-year-old business, he said it ensures a bad fate for his poor, rural customers, especially if Davenport's only other pharmacy moves in a similar direction.
Customers will either travel 30 or more miles to chain pharmacies for their drugs – no small feat for an elderly or disabled patient – or order medications through the mail, a potentially dangerous option for mentally ill patients who rely on face-to-face instructions, he said.
"If these patients can't get their medications or don't understand how to take them, a lot of the time they end up in emergency rooms," Paul said. Driving the need for the cuts, in part, is the more than $50 billion needed to recover from this year's storm damage to the Gulf Coast, especially from Hurricane Katrina. But when the waters ebbed from that disaster, another crisis was exposed: poverty.
That's why cutting programs for the poor seems unfair to Paul.
Washington Congresswoman Cathy McMorris said lawmakers began working on deficit reduction in April, though, before the hurricanes hit. Congress must slow the growth of the nation's big bills – Social Security, Medicare and Medicaid – if there's any hope of whittling down the deficit, she said.
"I think what we have to do is look at restructuring those programs in such a way so that the population that needs to be served is getting their needs met," McMorris said.
That means not allowing people to release significant assets in order to qualify for Medicaid, an abuse that McMorris said occurs. "There are some provisions put into this reform package that will try to keep that from happening," she said.
Critics this week pointed out that Republicans are asking for the cuts to social programs while pushing for more tax cuts.
"That's separate," McMorris said. "The (money) that we're targeting right now is specific to reducing the deficit."
McMorris said she has voiced concern about the bill's impact on independent pharmacies and is "trying to come up with some language that would protect them."
Marr thinks McMorris should be concerned in general. Any cuts to Medicaid disproportionately affect Eastern Washington because a higher percentage of Medicaid recipients reside here.
Deaconess, one of Empire's hospitals, loses about $13 million a year from people who can't pay their bills. Despite that challenge, the hospital has turned around a $35 million deficit in the last year by running itself more efficiently.
"If they cut Medicaid, we're back to square one again," Marr said.
While the Senate version of the bill passed virtually along party lines, the Associated Press reported this week that some moderate Republicans don't support the package.
If that's true, they join at least one other concerned party member.
Paul, the pharmacy owner, planned to find out Tuesday which political party was behind the proposed cuts. When the longtime Republican learned it was the GOP, he said it plays into that party's reputation for favoring big business over the poor.
"It would be very typical of what the Republican Party is standing for in the last few years," Paul said.
Staff photojournalist Holly Pickett contributed to this report.
