Governors Seek Help on Medicaid Costs
Published: March 1, 2011 - New York Times
WASHINGTON — Governors told Congress on Tuesday that President
Obama had not gone far enough in proposing
to let states opt out of major provisions of the new health care law in
2014, and they said they needed more immediate relief from the growing financial
burden of Medicaid.
“It sounds good, but it provides very, very little actual help,” Gov. Haley
Barbour of Mississippi, a Republican, said of Mr. Obama’s proposal.
The most important provisions of the federal law, including a big expansion
of Medicaid eligibility and a requirement that most Americans carry health
insurance, take effect in 2014. The federal government will initially pay
the entire cost of coverage for the people who are newly eligible for Medicaid,
but after several years, states will be required to pay some of the cost.
Gov. Gary R. Herbert of Utah, a Republican, said Medicaid had been a large
and growing part of his state’s budget even before the federal law was passed.
“In this recession,”
Mr. Herbert said, “Medicaid enrollment has skyrocketed. In December 2007,
enrollment in Utah stood at 158,267 individuals. In December 2010, enrollment
stood at 230,812 individuals, a 46 percent increase in three years.”
The governors testified at a hearing of the House Energy and Commerce Committee.
Gov. Deval
Patrick of Massachusetts, a Democrat, told the committee that he was largely
indifferent to the president’s proposal because his state had already overhauled
its health care system so that 98 percent of residents had health insurance.
The Republican governors said they were skeptical of the president’s proposal
because they would have to seek waivers, making the future of innovative state
health programs subject to the discretion of the secretary of health and human
services. In the past, they said, they have had difficulty obtaining permission
for such initiatives.
Mr. Herbert said Utah had been trying for eight months to get federal
permission to communicate with Medicaid recipients by e-mail and through a
secure Web site. Only after he raised the issue with Mr. Obama at the White
House on Monday did federal officials agree to the arrangement, Mr. Herbert
said.
Utah estimates that the move will save more than $6 million a year. Federal
officials said that Medicaid recipients had low incomes and that some might not
have access to computers. So in a letter approving Utah’s request, the Obama
administration said the state could use e-mail only if beneficiaries “elect to
receive notices through an electronic mailing system.”
Medicaid is now an open-ended entitlement, under which anyone who meets
eligibility requirements is entitled to benefits. Governors said they would
accept a fixed amount of federal money, in the form of a block grant, if they
had more freedom to tailor the program to their residents’ needs.
The new health care law generally prevents states from adopting more
restrictive eligibility requirements for Medicaid — for example, by lowering
personal income limits. The Republican Governors Association has
asked Mr. Obama to lift that constraint.
Representative Joe Pitts, Republican of Pennsylvania and chairman of the
Subcommittee on Health, said Congress might need to give states more latitude.
“If states cannot change their eligibility criteria,” Mr. Pitts said, “governors
are left with few choices but to cut payments to providers or cut other parts of
the state budget, such as education and transportation.”
But Representative Gene Green, Democrat of Texas, said, “States want the
federal government to write them a blank check.”
Based on his 20 years of experience as a state legislator, Mr. Green said,
that is not a good idea. In the absence of federal requirements, he said, Texas
might try to balance its budget by eliminating coverage for tens of thousands of
children.
Mr. Barbour said: “We can save money without taking people off the rolls. In
return for total flexibility in managing my Medicaid program, I would agree to a
block grant, with growth capped at half the national rate of increase. We should
not have to kowtow to Washington to get permission for every change.”
Jocelyn A. Guyer, co-executive director of the Center for Children and
Families at Georgetown
University, said the federal law also prohibited states from adopting
enrollment procedures that made it more difficult for people to sign up for
Medicaid.