Republicans shift focus to Medicaid complaints
Thursday, March 03, 2011
Republicans shift focus to Medicaid complaints
By: N.C. Aizenman, Washington Post
A day after President Obama said he would support amending the
health-care law so states can opt out of key provisions sooner,
Republicans sought to shift the rhetorical battle back to an issue
that would be largely unaffected by the president's proposal: the
impact of the law's Medicaid requirements on state budgets.
Testifying at a hearing of the House Energy and Commerce
Committee on Tuesday, two Republican governors returned to themes
that had dominated the discussion at the National Governors
Association's semiannual meeting over the weekend.
Mississippi Gov. Haley Barbour and Utah Gov. Gary R. Herbert
complained that by prohibiting states from limiting who is eligible
for Medicaid, the law has locked them into unsustainable spending
at a time of fiscal crisis.
"Worst of all," added Herbert, is the law's mandatory expansion
of Medicaid to cover a larger share of the poor beginning in
2014.
"Medicaid is poised to wreak havoc on the state's budget for
years to come," he said, "threatening our ability to fund critical
services, such as transportation and education."
To buttress that argument, congressional Republicans unveiled a
report by the committee's majority staff estimating that the
Medicaid expansion would cost states $118 billion through 2023 - a
substantially larger amount than recent estimates by the
Congressional Budget Office and independent analysts that consider
a shorter time frame.
At the hearing, the committee's chairman, Rep. Fred Upton
(R-Mich), pronounced the finding "sobering."
But administration officials countered that the additional
expense to states will be largely offset because the law also
enables states to save on Medicaid.
"It's important to remember that the Affordable Care Act will
cover the overwhelming majority of the costs associated with the
Medicaid expansion and will, in fact, reduce the amount states
spend to care for the uninsured," White House spokesman Jay Carney
told reporters.
Massachusetts Gov. Deval L. Patrick, the only Democrat
invited to speak at the hearing, sounded a similar note in his
testimony. "Federal reform is good for Massachusetts," he said. "It
has given us an affordable way to extend the promise of coverage to
Massachusetts residents."
Medicaid, which is jointly funded by states and the federal
government, now provides health insurance to 53 million poor
Americans. Starting in 2014, the law will require states to open
eligibility to an anticipated 20 million more people with slightly
higher incomes.
At first, the federal government will fully fund the extra cost.
But beginning in 2017, the states' share will gradually increase to
10 percent by 2020.
The report released Tuesday - which was jointly produced with
Republican staff of the Senate Finance Committee - arrived at its
grand total by compiling and extrapolating from separate estimates
provided by governments of each state as well as outside
experts.
These figures do not appear to include an analysis of several
potential sources of savings to states identified by researchers. A
recent report by analysts at the Urban Institute calculated these
savings could range from $40.6 billion to $131.9 billion between
2014 and 2019.
For example, the expansion of Medicaid coverage to a greater
share of the uninsured could enable states and local governments to
cut back on funding they now provide hospitals and other providers
for treating patients who are unable to pay. Similarly, states
whose Medicaid programs now cover people with incomes above the
minimum required by the law could shift those people to state-run
marketplaces, through which they will be able to buy insurance
plans with federal subsidies.