by Grace-Marie Turner, President of the Galen InstituteMedicaid is the rope in the current tug of war between the states and the federal government over health reform. So far, the feds think they are winning. But don't discount the strength and endurance of the states -- and especially the governors.
States are facing severe budget pressures. The 2009 stimulus package provided short-term cash to the states to shore up Medicaid -- the jointly funded federal-state health program for lower-income people. But in exchange, states had to agree to maintain their 2010 Medicaid eligibility levels or risk losing all federal matching funds.
In January, 33 governors and governors-elect wrote to President Barack Obama and congressional leaders requesting "flexibility and relief" from the "excessive constraints placed on us by healthcare-related federal mandates." States say they need to trim their Medicaid rolls now because they already are swimming in red ink and this circumstance will only get worse -- partly because stimulus funding that initially helped many of them pay for the added enrollment ends in June. And, while Health and Human Services Secretary Kathleen Sebelius has responded by sending her agency's Medicaid experts to the states to help them explore options to trim Medicaid spending, she is still urging states to do everything they can to keep Medicaid enrollment at current levels before the health law’s changes take effect in 2014.
These pleas for flexibility are bipartisan.
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