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Tuesday, January 15, 2013

Republicans react to Medicaid 'circuit breaker'

Posted by on Tue, Jan 15, 2013 at 12:13 PM

House Speaker Davy Carter image

I mentioned earlier that even Arizona Republican Gov. Jan Brewer had decided the economic argument in favor of accepting Medicaid expansion was too powerful to ignore. She has proposed there a "circuit breaker" provision that would automatically shrink the Medicaid program if federal support dropped. As it stands, the federal government is to pay the entire cost of Medicaid expansion for three years, then gradually pass along a small percentage to states, with a 10 percent cap in 2021.

The chance that the feds might back away from that level of funding some years from now has been a primary argument by Arkansas Republicans against taking expansion at all.

David Ramsey asked two legislators about the Arizona idea today.

House Majority Leader Bruce Westerman said:

"I’ve heard that concept tossed around. My understanding, the case law is once you start a government program you can’t just kick people off it, specifically here in the 8th circuit. My understanding in Arkansas if we expand Medicaid program we’re probably expanding it for good."

An important case indeed says Arkansas cannot stop a Medicaid program once started. But I think that's a separate question from, for example, altering the eligibility levels to reduce costs by covering only the poorest.

Westerman mostly stuck with his familiar refrain: "We don't have to do this now, there's no deadline."

Absent an alternative proposal, it still sounds to me like delay for the sake of delay; resistance for the sake of continuing committed resistance.

Ramsey also talked to Sen. Cecile Bledsoe, a doctor's wife who's emerged as a leading Republican spokeswoman on health issues, and asked about Beebe's reference to projected savings on the Medicaid expansion for the state.

"Not that I don’t believe it, but the federal government has to do their part," she said. "If we put all those people—250,000—on Medicaid and then we can’t afford it that would be a travesty."

This is a weird argument, isn't it? It would be a "travesty" to get free or almost free federal coverage for years and then lose some of it. But it would NOT be a travesty to decide not to take any expanded coverage ever, from day one.

As for a circuit breaker, she echoed Westerman:

"Does that mean people on the program would be kicked off? That's a problem we hope we will not have to face, we want to be sure. Since there’s no time certain, what’s the harm of waiting?" She added the legislature will "absolutely" decide this year.

House Speaker Davy Carter talked about Medicaid at his news conference. He complimented Beebe's speech and also said that he agreed with Beebe, despite remarks last week that sounded a little different, that solutions to the federal debt were Washington's, not Arkansas's. But he also continued his focus on fear about the state finding itself with more than a 10 percent match someday. (He and other Republicans rarely emphasize that the 10 percent match is eight years off.)

"... 10 percent of a dollar is still 10 cents. That's real money we’re adding to the money we’re already spending on Mediciad. It’s real money in addition to what we’re already spending. That’s the way I’m coming at this. That’s the current rules. Everybody in this chamber knows at some point someone in Washinton is going to come together and address the spending problem. Problem then becomes what happens when the rules here change. We’re one congressional compromise away from that changing. We have to make these long term decisions with all of that in the back of our minds. In that context federal deficit and debt does matter, it matters here, not any guarantees that it’s going to be a 90/10 split forever. I think they’re going to have to address that."

Similarity in talking points noted, along with the similar inclination to sacrifice health coverage today because of a concern that a law passed by Congress might not be in effect eight years from now. Still sounds like sugar-coated massive resistance to me.

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