Gov. Barbour, R-Miss., tells the committee that he cares more about Mississippians than they do. (Photo by Alanna Autler/Medill News Service)
WASHINGTON –Some governors said Tuesday they want to regain control over their Medicaid programs because President Obama’s landmark health care law will add unnecessary costs to their state budgets.
On Tuesday Governors Haley Barbour, R-Miss., Gary Herbert R-Utah, and Deval Patrick D-Mass., testified before the House Energy and Commerce Committee. They shared their unique experiences complying with the health care law’s mandates, particularly the difficulties imposed by requirements to keep their Medicaid eligibility in exchange for federal reimbursements.
As a result of Medicaid regulations, many states cannot afford to adjust coverage to focus on patients most in need or develop new strategies to reduce costs while providing quality health care.
If a state takes any action that makes eligibility for Medicaid more restrictive than the standards in effect for the state’s program as of March 2010 towards Medicaid, that state could lose all federal funding.
The hearing comes at a controversial time in the national health care debate. On Monday, Obama said that states can waive individual mandates in 2014 instead of 2017 if they can find better ways to extend insurance coverage to their citizens—a concession to Republicans who consider the mandate “unconstitutional.”
Gov. Deval Patrick, D-Mass., says health care reform has improved the quality of care in Massachusetts. (Photo by Alanna Autler/Medill News Service)
The committee hopes that states can act as a model for Washington, pushing lawmakers on Capitol Hill towards creative legislation that can save cash while extending quality coverage to citizens.
“Stop treating Medicaid as a one-size-fits-all dictate from the federal establishment and start giving states the flexibility to do what is in the best interests of their citizens,” said Gov. Tom Corbett of Pennsylvania, in a press release Monday.
After the reform last March, Pennsylvania’s Medicaid program saw an increase in the cost of its services, as well as the number of people it serves. Corbett said he blames “inflexible” federal regulations for Pennsylvania’s inability to balance its Medicaid budget.
The states expect to face $118 billion in Medicaid costs by 2023, said Committee chairman Rep. Upton. Medicaid spending nearly doubled between 2000 and 2009, and the program will add millions more to state budgets if Congress fully implements the reforms by 2014, according to a committee report.
Committee member Rep. Phil Gingrey, R-Ga., said that Medicaid costs force states to cut their budget in other areas. He cited a Rhode Island school board’s decision to fire all teachers at a struggling high school.
“How can our children compete in a global economy with an education? Mr. Obama, when our children can’t find a job, they’re going to need to stay on their parent’s health insurance plan,” Gingrey said.
He added that “Obamacare” need to be reexamined because its regulations make it difficult to purge people illegally reaping the benefits of the program.
But some Democrats on the committee dismissed the Republicans’ effort to expose state strife as a way to dismantle the Medicaid and repeal reform. Doing so could reverse the progress made since last March, they said.
“It will result in the loss of coverage for the most vulnerable and severely disabled and children it will exacerbate unfair distribution of dollars in states,” said Ranking Member Rep. Henry A. Waxman, D-Calif.
“The Affordable Care Act advances the common-sense philosophy of health care as a shared responsibility between state and federal governments,” said Rep. Frank Pallone, Jr., D-N.J.
The governors presented their states’ cases before the committee, stressing how they have implemented Medicaid since reform.
Gov. Patrick, D-Mass., lauded the federal government for its health care reforms, saying Medicaid did not burden Massachusetts. The state adopted a similar universal system that he says works for its citizens. A “hybrid solution” exists in which the government offers private insurance in the open market with competitive prices; citizens can choose their own doctors.
But Patrick also backs Obama’s health reforms because he says the Affordable Care Act can reduce the deficit by $124 billion through 2019; Massachusetts itself suffers from $1 billion deficit. Patrick denied that health care reform damages unemployment rates and growing debt; rather, it has improved the state’s bond rating.
“This has nothing to do with universal care, it’s the way we incentivize how we pay for it. Right now, we pay for the number of times you’re in and out of care, and not the quality of that care.”
But Gov. Barbour, R-Miss., said the government’s extended Medicaid program could threaten the health of his state. Mississippi has prospered from personalizing its system, Barbour said.
He used the example that Medicaid cannot require beneficiaries to schedule an annual exam—a handicap in Mississippi, which has some of the highest incidents of obesity, heart disease, and diabetes.
“If we could require Medicaid beneficiaries to have an annual exam, it would allow for early detection and proper treatment, improving the quality of life for thousands of Mississippians,” Barbour said.
Barbour and Herbert also opposed the expanded Medicaid eligibility requirements under the health reform law. By 2014, all individuals under the age of 65 with incomes up to 133 percent of the federal poverty level will be eligible for the program.
“Utah is a young state. I have a whole different demographic to deal with on health care than another [state] that deals with an aging population,” Herbert said.
Broad eligibility requirements contribute to the reform’s unconstitutionality, he said, which has recently been contested in a number of federal courts.
Committee Democrats grilled the governors on the effectiveness of their tailored programs, arguing that state deficits reflect poor leadership, not faulty health legislation.
“You know that you bear no additional costs before 2017, you know that right?” jeered Rep. Anthony Weiner, D-N.Y. “If your number of poor people goes down before 2017 and you’re a good governor, your Medicaid costs will go down.”
An alternative to federal regulations is a block grant that allows states to fund and administer their own programs. State could receive this cash in exchange for a 50 percent reduction rate in reimbursements.
“We shouldn’t have to come up here and kiss the ring and get permission from Washington to help our people,” Barbour said. “Give us a block grant with total flexibility…and we can reduce costs for the federal government.”
