Republicans have a new target, and its name is Medicaid. A few weeks ago, at the sidelines of the budget debate, Republicans quietly began to float proposals to roll back this health care program for the nation’s most vulnerable. In Washington this week, those under-the-radar whispers grew to a roar as GOP governors called on Congress to let them have their own way with the program.
As it stands now, states receive a percentage of their Medicaid money from the feds—based on the size of their beneficiary pool, among other factors. In exchange, they must follow guidelines governing minimum benefits they must offer and who must be eligible. Under health care reform, more than 12 million Americans will join the Medicaid rolls, and states will no longer be able to skimp on benefits.
The governors claim that their goal is to make these programs “efficient.” Some are more honest than others:
Barbour insisted that GOP-led reform wouldn’t necessarily mean kicking people off the rolls. But he blasted federal changes that would force states like Mississippi to enrich bare-bones benefit packages and bring more people on board. “We don’t want extremely high mandatory standard benefits packages,” he testified. “Some politicians act like they love our constituents more than we do.”
Given that Mississippi ranks dead last in terms of healthy residents, it seems likely that he’s right – some other politicians DO love their constituents more than he does.
The real issue here is that beginning in 2014, as a result of the health insurance reform bill, millions more people will be eligible for Medicaid.
Kaiser Health News provides a rational look at what turning Medicaid into block grants might mean:
Governors have long lobbied for a freer hand on Medicaid, which they say would result in a cheaper, more effective program. Lately, Republican governors have more aggressively pursued the block-grant idea, partly because they’re worried about the cost of adding millions more people to the program beginning in 2014. (The federal government will pick up the whole tab for new enrollees for the first three years, tapering down to 90 percent in 2020 and beyond.) Governors also are alarmed at Medicaid’s growth rate, which the CBO estimates at 7 percent annually over the next decade. The program, some state officials say, is crowding out other needs, such as education.
The Republican governors also have other reasons to complain about Medicaid’s costs. They’re pushing hard to get leeway from the Obama administration on a rule barring them from tightening Medicaid eligibility before 2014. Some governors want to cut people from the rolls right away.
None of these governors seem too concerned with the health of their residents, which is interesting – but most of all I notice that there is no discussion of WHY Medicaid enrollment is on the rise. No one is pointing out that the most effective way to decrease that rise in Medicaid is employment.
The topic of unemployment and job creation has disappeared from our national dialogue.