“We should not have to come to Washington on bended knee and kowtow for waivers,” Mississippi Gov. and RGA Policy Chairman Haley Barbour told a press roundtable about the RGA’s new repot, A New Medicaid: A Flexible, Innovative and Accountable Future. “The idea that Washington loves our constituents more than we do is offensive and false.”
The 16-page report, produced by the Republican Governor’s Policy Committee, was produced in response to a joint May 11th letter from House Energy and Commerce Chairman Fred Upton, R-Mich., and Senate Finance Committee Ranking Member Orrin Hatch asking Republican governors for their input on how to reform Medicaid.
The report identifies seven guiding principles and 31 specific policy recommendations, but its essence can be boiled down to just one sentence: get the federal government off our back.
Dennis Smith, Secretary of the Wisconsin Department of Health Services, pointed out that the vast majority of Medicaid spending has come from state led, not federal expansions. But every time any state innovates or experiments with Medicaid policy the federal government comes in and takes over. “States are not agents of the federal government,” Smith said. Some states, including New York and Virginia even pay more than half of their Medicaid bills.
Smith stressed that despite the Obama administrations encouraging rhetoric about flexibility, on the ground level obtaining actual waivers from the Centers for Medicare and Medicaid Services (CMS) has only become more difficult. Any effort to experiment with cost sharing, like higher co-pays for prescription drugs or doctor’s visits, are met with fierce resistance from the Obama administration.
Barbour offered one example from his state’s efforts coordinate care between health care providers. Barbour said the waiver process took over year and after the CMS initially signed off on the program they later came back and demanded changes to the payment schedule. “Waiting a year plus was bad enough, but getting off the end of the diving board and finding there wasn’t any water in the pool was pretty tough.”
Medicaid is the fastest growing part of most state budgets. It already consumes between 15 and 25 percent of most state spending. By 2030, the Deloite Center for Health Solutions predicts that number will rise to 35 percent. States will face a choice between meeting their federal Medicaid spending requirements and firing police, teachers, and other state employees.
Obamacare achieves more than half of its health insurance expansion through looser Medicaid eligibility requirements, and while some of the costs for that expansion are paid the federal government early on, costs are shifted to states as time goes on. Bruce Greenstein, Secretary of the Louisiana Department of Health and Hospitals, said, “Cost shifting does not equal cost savings. Too much of the discussion in regard to reducing the cost of Medicaid has been merely mechanisms that shift responsibilities from the federal government to states. That is not what Medicaid reform is about.”
