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Posts Tagged ‘expansion’
March 16th, 2013 at 3:22 pm
WSJ: GOP Medicaid Flippers’ Wishful Thinking

An editorial in the Wall Street Journal nails a specious legal argument by at least two GOP governors trying to convince their Republican legislatures to approve the ObamaCare Medicaid expansion now, with the intention of opting out when the state’s bill comes due in three years.

The argument, a product of a private law firm in Ohio, makes some nice lawyer’s points, but ultimately fails to take into account how government programs – and the politics that drive them – actually work:

But there’s no evidence in the original law or the Supreme Court opinion that states can join or leave at their own whim. The logic of Justice Roberts’s opinion  [upholding ObamaCare] suggests that once states adopt new Medicaid, the program immediately becomes the old program for the purposes of the law and then states can’t leave.

The Becker memo also cites “guidance” from the federal Health and Human Services Department that states “may decide later to drop the coverage.” But these informal documents on the HHS website lack the force of law or even of regulation; they aren’t part of the Federal Register. In any case, HHS doesn’t have such authority. Congress didn’t grant the Administration any more statutory leeway than it did the states.

We wouldn’t be surprised if HHS is promising flexibility now only to revoke it later as a deliberate bait and switch. That wouldn’t be any more deceptive than Mr. Kasich’s legal claims. Republicans tempted to sign up for ObamaCare’s Medicaid expansion had better think twice because once they do, the likelihood is they’re ceding control forever.

The decision facing Republican legislatures is straightforward: Either continue with Medicaid as it is and have (some) discretion over your state budget, or accept ObamaCare’s expansion and get ready to lose control.

It’s time for the GOP flip-floppers to be honest about the implications of this decision and debate the choice, and the consequences, on the merits.

February 8th, 2013 at 8:15 pm
Indiana’s Pence Wants Sensible Reform to Medicaid Expansion

Like Ohio’s John Kasich and four other Republican governors, Indiana’s Mike Pence seriously considered expanding Medicaid eligibility under ObamaCare.  But unlike Kasich & Company, Pence ultimately decided against it when HHS refused to grant him one sensible reform.

Established under Mitch Daniels, Pence’s predecessor, the Healthy Indiana program allows uninsured adults aged 19-64 to use a state-based health savings account to pay for medical expenses, such as doctor’s visits, hospital services, diagnostic tests, and prescription drugs.  Incentives apply to reward cost-effective spending, but it’s critical to point out that the spending decisions within the account are determined by the policyholder, not the state.

In order to go along with expansion under ObamaCare that increases the eligibility pool for Medicaid, Pence asked permission to use Healthy Indiana accounts to help keep costs down.  The request is imminently reasonable.  If the purpose of Medicaid expansion is to cover uninsured people, why not let Indiana migrate a state-based program with a 94% satisfaction rating?

Predictably, Kathleen Sebelius’ Department of Health and Human Services said no, preferring to retain federal control over coverage and spending.  Without a program like Healthy Indiana in place, costs are likely to spiral upward since Medicaid beneficiaries are not tethered to the consequences of their spending decisions.

So, Pence said no to the Medicaid expansion.  But I think it’s crucial to understand that his response was not a kneejerk reaction against helping the uninsured get normal access to healthcare.  Instead, he proposed a sensible reform that would have accomplished the same goal as Medicaid expansion, but with more cost certainty for the state budget, and thus less tax receipts from taxpayers.

I’ve speculated before that Pence might be the GOP’s best bet in the 2016 presidential race.  A moment like this, even when it doesn’t result in a “win” politically speaking, helps confirm that suspicion because it’s based on sound principles.