State Rep. Barbara Cooper (D-Tenn.)

WASHINGTON-African American state representatives and senators-already embattled because of past crippling budget cuts-are predicting that the Medicaid program may be the hardest hit of the "Big Four" entitlements now on the chopping block by conservative Republicans and Tea Partiers.

They say the aim is to hurt minorities and the poor, and balance the federal deficit on their backs.

The other major entitlements include Social Security, Medicare and Defense. President Barack Obama has not indicated which of the entitlements may face his ax, but Sen. Richard Durbin (D-Illinois) who is a close confidant, has said that only Social Security will be spared.

Medicaid is the more vulnerable program to be gutted because the recipients tend to be poor and minorities, who are not among the nation's largest group of voters.

If successful, the campaign by conservatives to target Medicaid could lead to a rationing of healthcare for the poor-denying them basic services such as access to physicians, nurses, and other essential providers; the dispensing of outdated generic drugs instead of state-of-the-art brand-name drugs; reductions in testing and examinations, as well as the establishment of new rigid, eligibility requirements that would prevent many of the applicants from receiving Medicaid services.

"Half the people worked all of their lives and many of them are still picking cotton, berries and fruit to make a living in some parts of the United States," State Rep. Barbara Cooper (D-Tenn.) told The Spiritual Herald. "When they get older and cannot take of themselves, then they need something to rely on.

"If they don't have Medicaid to take care of them then what happens is they just die off. How are we going to reject the most needy and just leave them hanging out there?"

Medicaid, the primary or only healthcare for about 60 million poor or disabled Americans and children, is also threatened with looming destruction leading to privatization in the near future-or even sooner, according to some pundits. For years, the insurance industry has been eyeing Medicaid for a takeover.

Medicaid, a $373.9 billion-and-growing program, is also under attack by state governors who are concerned about what they call a $14 trillion national deficit.

House Republicans, a razor-thin Democrat Senate majority and President Obama all indicate Medicaid will be cut but none want the responsibility of being the first to slash a vital program supported by most Americans. Obama's proposed $3.7 trillion budget trimmed Health and Human Services by only 1 percent, while Republicans talk billions.

State governors, over half of which are Republicans, as well as more than 80 new Tea Party and other conservative House members, see a money problem. But for the poor, however, it is a matter of life and death.

Medicaid, unlike Social Security and Medicare, is controlled by the states. However, former President Bill Clinton seized power from the governors and state legislatures in the mid-1990s, giving his administration control over the state-created program. He also helped several insurance companies gain greater access and control over the Medicaid Program. It started in Tennessee under the so-called "TennCare Program," which created a system of rationing for the poor.

"You can't get rid of it. Medicaid's got to survive. It's got to stay," declared Rep. Earle Banks (D-Mississippi) of Hinds County. "I would hope that if Medicaid was cut that everything else would be cut also, because if other things are not cut, all the cuts would be on Medicaid."

"Medicaid is one of the programs that could be cut," Rep. Jewell Williams (D-Pa.) of North Philadelphia agreed. "I think it's vulnerable. It would affect a high number of African Americans when you take away a program like that.

"Pennsylvania is a Republican-controlled state. A lot of cuts and reforms are normally on the backs of minorities and poor people."

Indeed, of the four big cost-heavy federal budget areas-Medicare, Social Security, the military and Medicaid-it is Medicaid that is the most likely to be cut, according to the state politicians, because African Americans are only 14 percent of the population, which is not a strong voting bloc.

Medicaid cuts thus seem inescapable. New York Medicaid Director Jason Helgerson wants to cut $2 billion from the state's $52 billion Medicaid budget, which means $4 billion as Washington matches funding.

Medicaid, created in 1965 through Title XIX of the Social Security Act and funded 50-50 by the states and the Center for Medicare and Medicaid Services (CMS), served 48.5 million Americans in 2009, one in six people, and the Affordable Health Care Law would add 32 million more by 2014.

Individual states set their own funding, which is matched by CMS dollar for dollar, and so states and governors have control of funding, but not of the growing numbers of the poor needing care. Gradually, states needed more than 50 percent from CMS-some 70 or 80 percent-and virtually every state now runs a deficit.

By the mid-90s, costs drove President Clinton to control Medicaid costs in Tennessee with TennCare, bypassing the State Legislature and working with Gov. Ned McWhorter to hand the program to 12 insurance companies, which reined in costs by cutting services even as it covered more people. The result was less care for all, but cost control for Tennessee.

The Impoverished Poor

The system spread to other states, "Medi-Cal" in California, "MassHealth" in Massachusetts, "Oregon Health Plan" in Oregon, Department of Children and Families in Florida. States bundled together the administration of Medicaid with the Children's Health Insurance Program (CHIP).

Other states sought "waivers" to restrict Medicaid care, and now "waivers" are granted to Arizona, Ohio, New Jersey, Florida, Tennessee and others. With the new Affordable Health Care Act state governors and Republicans continue to push to shave Medicare or dismantle it.

States handing the administration of Medicaid to HMOs, health management organization insurance companies, privatizes the program, allows insurance firms to restrict and ration health care for the poor, and allows states to cut their budgets.

It is the goal of states, the insurance industry, Republican deficit hawks and Washington with its "waivers" and TennCare-like systems, but threatens the health and lives of 60 million Americans on Medicaid.

" I know we can't do everything, but we can do what is needed," said Representative Cooper, and called on the black church to help.

"The clergy is going to have to take on a big role and step into what's going on across the country," she said. "And they can do something. They act as if African Americans don't vote for Republicans but we do. And we are not organizing and taking advantage of that vote.

"If some of them don't get the African American vote they can lose. Some of the Republicans take us for granted because we don't have votes."

She lamented some silent voices. "The NAACP down here doesn't really in my observation for the most part meet the mass needs of the African Americans where it really, really counts."

Said Rep. Williams, "I am very much concerned about the future of Medicaid because what of what is happening in the White House and in our local government. We are in a Republican controlling state and we have a Republican governor."

"Any cuts in Medicaid would have a devastating effect on the healthcare of so many, and children across the nation," said Rep. Banks. "If it's all coming out of Medicaid then the whole load is there.

"If Medicaid is cut and Social Security is cut and other types of programs are cut then it's not all on Medicaid. I don't advocate any cuts certainly. I advocate cuts of building aircraft carriers for the military. Cut back on a couple of the jets that are under construction, which cost hundreds of millions of dollars.

"The reality is they could talk about cuts, cuts, cuts, but in the end it's their doctors, their nurses, their hospitals, that get it all. The pharmaceutical companies are getting the benefits of it. The impoverished, poor, elderly and the children are the people who have no benefits.

"The payment, eventually all of the money, is going to doctors, nurses and the hospitals and all the administration."

The state politicians agreed that although Medicaid is a state program, the power is now in the hands of the Congress in Washington, which is expected to take up the issue of entitlements sometime in March.