Last week, I noted a number of states whose governors were refusing the Medicaid expansion under the Affordable Care Act because of the costs the expansion would impose. Over the weekend, Politico reported that several other governors are willing to accept the expansion—but only if it comes with federal flexibility.
At the National Governors Association meeting in Williamsburg, Va., on Friday, Virginia Gov. Bob McDonnell, Nebraska Gov. Dave Heineman, Utah Gov. Gary Herbert, Tennessee Gov. Bill Haslam, and Wyoming Gov. Matt Mead all said their opposition to expanding Medicaid wasn’t absolute. If the Obama administration would throw in more flexibility to run their Medicaid programs their way, they said, they might be more willing to talk about expanding their programs.
Here’s how Herbert put it: “They ought to be giving all states more flexibility, block grant the money and let us find our own unique ways with our own unique populations and demographics to find the best way to provide health care. … The key word is flexibility.”
Indeed, the issue goes beyond the expansion of Medicaid eligibility to the very sustainability of the current system. A recent presentation given by Secretary of Public Welfare Gary Alexander to the American Enterprise Institute highlights the long term trends in Medicaid growth. In 1965, there were 17.9 workers for every American on Medicaid. Today, the ratio is 2.5 worker to one recipient, and 1.9 to one when only looking at workers in the private sector.
Reforms that promote work and independence from government would save money and improve the lives of the poor, ending the cycle of poverty. However, such reforms cannot happen unless states get approval from the federal government. A recent Wall Street Journal piece suggests this may not be likely:
What almost every U.S. Governor wants most of all is more flexibility to manage Medicaid caseloads and reform how the program operates. ObamaCare locked in “maintenance of effort” rules that prevent any changes at all, much less state experimentation. On Tuesday Health and Human Services Secretary Kathleen Sebelius warned states that “The Court’s decision does not affect other provisions of the law,” which is another way of saying drop dead. States will get no meaningful policy waivers from the Obama crowd.
Even if Pennsylvania refuses to expand Medicaid, federal flexibility is essential to preserving our social safety net.