MEDICARE: Expensive, Successful MEDICAID: Chaotic, Irrevocable

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Though Part B of Medicare has worked just about as well as Part A, it is also hopelessly in the red. Under the original law, HEW Secretary John Gardner was required to announce this week what the premium rates would be for 1968 and 1969. Last week he begged off, and both houses of Congress scurried to pass a reprieve bill, giving the Administration until Jan. 1 to decide what rates will become effective next April 1—most likely $4, depending partly upon what services Congress decides to cover.

MEDICAID

Title XIX of the 1965 Social Security amendments put the Federal Government in the position of matching, on a sliding scale, payments made by the states for the medical care of the indigent—meaning essentially those receiving welfare payments. The law went further, enabling states to create a new class of "medically indigent"—those able to feed, house and clothe themselves, but who would neglect their medical and dental care because of difficulty in meeting even routine bills and who would be pauperized by the costs of a major illness.

Dubbed Medicaid, Title XIX left it up to the states until 1970 to decide whether they wanted any part of the plan. It also left it to the states to decide which of their citizens should be classed as indigent or medically indigent and entitled to benefits. If a state wanted to tap the U.S. Treasury, it had to provide coverage for a minimum of five essential services-in-patient and out-patient hospital care, doctors' care, X rays, lab tests and nursing-home benefits. Optional frills included home health services, dental care, eyeglasses, drugs, physiotherapy, private-duty nursing, podiatry, hearing aids, chiropractic and even the services of naturopaths. When a plan was finally approved, the federal handout was scaled to the state's income level: 50% for New York and California for exam ple, 65% for Utah. (It would be 83% for Mississippi, if that recalcitrant state were to participate.)

So far, 22 states are implementing Medicaid with benefits for both the indigent and the "medically needy." Sixteen have adopted it, or are in the process of doing so, for welfare recipients only. Twelve others have not made a decision as yet.

$6,000 in New York. It was left to the states to decide how much income a family not on welfare could have and still be rated as "medically needy." Oklahoma set it at a low, low $2,448 for a family of four. In most states the amount ranged between $3,000 and $4,000, with an infinite variety of limitations as to what cash, liquid assets, equity in a car, and life insurance the family might be allowed to keep. California, though it set the four-member family income limit at a median $3,900, offered an estimated 2,500,000 eligibles every conceivable health service that HEW would approve.

Except for naturopaths, so did New York, which classed a family of four with $6,000 a year as medically indigent. New York was already providing most of the recommended services at its own expense. By signing up under Title XIX, it got a federal windfall of $217 million for one year.