The new Chairman of the Energy and Commerce Committee
invited three of the nation’s governors to testify at a hearing entitled “The
Consequences of Obamacare: Impact on Medicaid and State Health Care
Reform.” As the title of the
hearing suggests, the event was heavy on posturing and politics and light on
illuminating substance. Governor Haley Barbour of Mississippi, in particular, was in fine form, arguing forcefully for a Medicaid
block grant at Tuesday’s hearing.
On his swing through Washington, he delivered a series of zingers that
served to disparage Medicaid, including conjuring up the image of beneficiaries
driving up to pharmacy windows in their BMWs and refusing to make co-payments
that harkened back to the fictitious “welfare queens” of the Reagan era. (I’m sure I don’t need to remind Say
Ahhh! readers, that this is about as realistic as Anne Hathaway hosting the
Academy Awards in sweat pants with no wardrobe changes).
While his delivery wasn’t quite as jovial, Representative
Henry Waxman, ranking member of the committee, did ask Governor Barbour the key
question – who is it that Mississippi would like to have the flexibility to cut
off? The state’s low-income
children (who won’t save much money because they are inexpensive to coverage)
or its seniors and people with disabilities (who do cost a lot of money, but
desperately need care)?
Interestingly, and here we actually get to a touch of substance,
Governor Barbour said that he didn’t want to cut anyone off, and instead, said
he controlled his Medicaid costs by, among other things, requiring a
face-to-face interview once a year.
When asked by a Member of the panel about whether or not the MOE would
actually prohibit him from using this roadblock to coverage, the Governor had
to admit that it does not prevent him from doing so since it was in place when
ACA was signed into law.
The fact that Governor Barbour is so proud of his
out-dated strategy for denying kids coverage that he was willing to spend his
limited time testifying before Congress about something that doesn’t impact his
state is somewhat puzzling. Is it
an effort to encourage other states to follow his lead by employing this
draconian practice if the stability protections are rescinded? As we talked about in more detail in
our recent paper on the impact of rescinding the stability protections, states don’t often directly eliminate coverage for children – too
politically unpopular – but in the last recession, 23 states did set up
backdoor roadblocks to coverage by adding paperwork barriers to enrollment.
Governor Patrick of Massachusetts made a strong pitch for
the extensive flexibility already in the health reform law and gave practical
information on how a similar model has worked in Massachusetts. He highlighted that the state now is
covering 98 percent of people – and 99.98 percent of kids – and noted that
Massachusetts has managed to successfully manage health reform while at the
same time the Commonwealth invested record-high levels of funding into its
education system. The major
challenge now for the state is tackling rising private health insurance
premiums, which Governor Patrick pointed out is an issue throughout the country
and something the Affordable Care Act provides the states the tools to deal
with more effectively.
Governor Herbert of Utah also made a strong pitch for
more state flexibility, and talked in detail about his positive feelings about
his state’s exchange.
Unfortunately, though, no one asked him for the hard data on how many
people it serves and how effective it has been in addressing the goals of
reducing costs and covering uninsured people in Utah. It will take another hearing, perhaps on a less politically
overheated day, to untangle the impact of the Utah exchange.