Each time I read a story like the one that follows, I start bouncing off the ceiling. Who could cobble together such a convoluted, outright mean-spirited, and stupid, plan for offering--and withholding--treatment and stiffing the providers of that care. Of course, it's the people who know the price of everything and the value of nothing. These are people who make Scrooge seem like Santa by comparison. But, you know, that is too kind a tone. These cretins are vile little shits who dole out treatment while withholding compassion. They besmirch the compact between the people and their government and its elected officials, all the while imagining that whatever cost-cutting measures they take will somehow improve health care delivery and the quality of care. The rest of the world looks on in amazement and disgust. Medicaid Cuts Rile Doctors Hospitals Also Fight Washington State's Drive to Trim Emergency-Room Visits By ANNA WILDE MATHEWS A plan by Washington state's Medicaid agency to stop paying for certain emergency-room visits is prompting pushback from hospitals and doctors, who say they will be stuck with bills for vital care they often are legally required to provide. The new cuts, set for April 1, focus on about 500 diagnoses including common infections, mild burns, strains and bruises. If an enrollee comes to an emergency room and is diagnosed with one of these conditions, the Washington Medicaid program won't pay the hospital and doctors. Doctors and hospitals are up in arms about a Washington state Medicaid cut that will deny coverage if beneficiaries go to the ER for any of about 500 conditions including a number of common infections. Anna Mathews has details on The News Hub. Instead, the state will pay a screening fee of about $50 if the patient is in a private-plan version of Medicaid, which currently enrolls about 60% of beneficiaries and is slated to grow. Patients won't be charged. The move would be the latest cut to Medicaid programs as states struggle to reduce health-care costs—and as the downturn has boosted Medicaid's ranks. Some 43 states have Medicaid initiatives designed to deter unnecessary use of emergency rooms, according to the Kaiser Family Foundation, a nonpartisan, nonprofit organization that studies health issues. Several states now charge patients copays for nonemergency services in an ER. The Washington policy is being watched by other states, said Alan Weil, executive director of the National Academy for State Health Policy, a nonpartisan research organization. Washington's legislature last spring ordered the Medicaid agency to cut spending on unnecessary ER visits, spurred by a budget shortfall then projected at $2 billion. Officials say too much routine care is given in ERs, often the most expensive setting, and that this plan would save the state $17 million a year. Doctors and hospitals, which got an earlier version of the plan blocked on procedural grounds after suing the state, say the new effort goes too far. They say the cuts would put them in a bind because federal law requires them to screen and stabilize all patients, which may involve imaging and lab tests. Stephen Brashear for The Wall Street Journal Stephen Anderson, head of Washington state's emergency-physicians group, says a new policy would saddle hospitals and doctors with unpaid bills. Moreover, because of ethical and liability concerns, hospitals often will have to treat some conditions the state considers nonurgent, such as urinary-tract infections, they say. The upshot, they say, is they will be forced to do unpaid work, and the costs ultimately could be shifted to private health-care payers. "If you fall down the stairs, and your ankle is twice its normal size, and I X-ray it and it's broken, they'll pay me, and if I X-ray it and it's not broken, they won't," said Stephen Anderson, president of the Washington chapter of the American College of Emergency Physicians. The doctors say that patients, even though they face no bills themselves, may feel pressure to avoid coming to the hospital even if they urgently need care due in part to publicity about the state's effort. They also argue that a number of diagnoses on the list are relatively serious conditions, such as candidal endocarditis, which involves fungal infection of the heart. State officials say procedures such as pregnancy tests don't belong in the ER. State officials say that for many situations, emergency-room staff can make a quick assessment and steer patients toward a lower-cost venue, like an urgent-care clinic, without extensive testing. For ankle pain, for example, doctors have evaluation guidelines, and "screening procedures don't need to go on to X-rays" in all cases, said Jeff Thompson, chief medical officer of the state agency that oversees Medicaid, the Health Care Authority. "We will be happy to work with doctors and hospitals to ensure care is done appropriately and in the appropriate time frame," Dr. Thompson said. He said if a patient with the heart infection had symptoms that required hospital admission, that would be paid, but a chronic case without symptoms might not be covered in an emergency visit. The agency also will cooperate with providers to ensure the excluded diagnoses are appropriate, and it plans to add and subtract from the list it issued, Dr. Thompson said. He said procedures such as pregnancy tests and most well-baby exams shouldn't occur in an emergency room. The state also is focused on Medicaid beneficiaries with histories of frequent emergency-room use or narcotics abuse, and visits by these people will get a special review. Stephen Brashear for The Wall Street Journal Dr. Nathan Schlicher at St. Joseph Medical Center in Tacoma, Wash. A spokesman for the Centers for Medicare and Medicaid Services, the federal agency that oversees Medicaid, said it is "in touch with Washington state officials regarding their plans." Washington state's emergency-physicians group, as well its medical and hospital associations, are lobbying legislators and officials to halt the initiative. The groups have outlined an alternative plan to save money, which includes boosting use of generic drugs and monitoring frequent ER users. Other states are taking similar tacks. Since July in Tennessee, Medicaid pays only a $50 ER screening fee for diagnoses considered nonurgent, though it excludes children under two. Iowa in September launched a tiered plan that cuts payment for emergency visits for nonurgent conditions, but it doesn't apply to enrollees younger than 21, among other groups. The earlier version of the Washington policy, which was blocked by a state court in November after the doctor and hospital groups sued the state, would have allowed three nonemergency ER visits before the program refused to pay. "States are looking for any possible way to reduce spending," said Diane Rowland, executive vice president of the Kaiser Family Foundation. Medicaid beneficiaries go to the ER more often than others, according to an analysis from the Centers for Disease Control and Prevention, partly because they don't always have access to other doctors. But by and large, states have limited levers to trim their Medicaid tabs: The federal health overhaul law generally forbids them from reducing the populations they cover, and states are required to provide certain benefits. The number of people eligible for the program is expected to expand sharply in 2014 under the health overhaul. Federal and state laws often require that insurers cover ER visits that occur for reasons that a "prudent layperson" would consider an emergency, said Thomas Barker, an attorney at the firm Foley Hoag. That standard applies to all plans provided by employers that are self-insured, as well as private-plan versions of Medicare and Medicaid. It doesn't necessarily apply to traditional Medicaid, though, he said. Regardless of what they are paid, hospitals are obligated under a different federal law, the Emergency Medical Treatment and Labor Act, to provide a "medical screening examination" to anyone who asks, Mr. Barker said, and if the person has an "emergency medical condition" the hospital either must stabilize it or arrange to transfer the patient to another hospital that can do so.