State and federal officials say they have begun to measure the health effects of Hurricane Katrina not in months but in years. This comes as both evacuees and the medical systems upon which they rely struggle to recover from the storm’s impact.

Lawmakers announced Monday that they would soon make a proposal providing full federal coverage for hurricane victims’ short-term medical costs.

Meanwhile, officials are beginning to wonder how to go about rebuilding public health systems that were destroyed by the storm in Louisiana, Alabama, and Mississippi. Their decisions are likely to have a profound impact on the long-term care of hundreds of thousands of storm-area residents, many of whom relied on public services and charity clinics that were wiped out.

The storm’s destruction “decimated” Medicaid offices, hospitals, welfare centers, and other social service locales, according to U.S. Surgeon General Richard Carmona. “It’s all gone,” he said at a Capitol Hill briefing.

Carmona said health planners have become less concerned with the broken bones and cases of food poisoning that occurred in the last two weeks and far more worried about how to give ongoing care to the thousands of infants, elderly, disabled, and chronically ill people displaced by Katrina.

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Moving Forward From Katrina

Standard health operations -- such as delivering routine childhood vaccinations or administering a steady supply of blood pressure medication to heart disease patients -- rely on an infrastructure of clinics and record keeping that is largely destroyed.

Services were already spotty in Louisiana, Alabama, and Mississippi, which before the storm were at or near the bottom of national rankings for delivering health services to the poor, Rowland said.

“We’ve got to go in and almost rebuild an entire infrastructure, a health infrastructure, in that particular area,” says Ray Sheppach, executive director of the National Governors Association.

Experts expect the disaster’s impact to place a strain in social and health services for years to come. Rates of depression, suicide and divorce are all known to rise in the months and years following large natural disasters or wars, Carmona said.

“Make no mistake that these public health needs are going to be very, very large and they’re going to go on for a long time,” he said.

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Emergency Aid Bill Proposed

Meanwhile, two key lawmakers said Monday that the federal government will pay all short-term medical costs for victims of Hurricane Katrina.

Sens. Charles E. Grassley, R-Iowa, and Max Baucus, D-Mont., told reporters that they will introduce an emergency aid bill tomorrow calling for full federal payment for victims’ Medicaid costs over the next few months.

The senators, who head the Finance Committee, also said that all evacuees affected by the storm would be entitled to services even if they would not ordinarily qualify for the program.

Washington shares Medicaid costs with the states according to varying formulas, and mass evacuations in Katrina’s wake left states pleading for increased federal help for evacuees who fled the Gulf coast for other states.

Bush administration officials announced on Friday that they would allow states to speed up Medicaid enrollment processes in an effort to remove red tape for Medicaid care. But it remained unclear whether patients not eligible for Medicaid before the storm would be entitled to emergency health coverage under the program.

“You’re entitled to Medicaid regardless of your income,” Baucus told reporters at a news conference along with Grassley. “Don’t worry about your health care.”

Arkansas, Texas, and other states surrounding the Gulf coast disaster area were also waiting to hear whether the federal government would pick up the bill for the care or force states to share it.

Affected states would also receive a “100 percent federal match” for their added Medicaid costs, Baucus said, though it remained unclear how long the increased payments would last.

The move is likely to please Medicaid advocates, some of whom had worried aloud that Bush officials and Congress might reserve coverage for patients who were already qualified for Medicaid when the storm hit. Many thousands more became effectively destitute when they lost their incomes and homes to the storm.

“What they should be saying is, ‘If you’re a survivor of Katrina and you need medical care, the federal government is going to provide it,’” Diane Rowland, the executive vice president of the Henry J. Kaiser Family Foundation, told WebMD.

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By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: Richard Carmona, MD, U.S. Surgeon General. Diane Rowland, executive vice president, Henry J. Kaiser Family Foundation. Ray Sheppach, executive director, National Governors Association. Sen. Max Baucus, D-Mont.