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Friday, February 1, 2013

Taking the temperature of the Medicaid expansion debate: Bryan King wants to rid his system of waste

Posted by on Fri, Feb 1, 2013 at 12:20 PM

Today’s chances of passing expansion: 38%
Last week’s chances: 45%
See here for previous entries on the Expand-o-Meter

Sen. King wants to rid his system of waste
  • Sen. King wants to rid his system of waste

Republican lawmakers went back to their old standby this week to fight Medicaid expansion: Waste! Fraud! Abuse! Get ready to hear some harrowing tales of Medicaid Queens riding around Mountain View in convertibles from Sen. Missy Irvin.

Looked like it would be a slow week for the expansion debate with other stories dominating the news but on Wednesday, things got lively in the Legislative Audit committee meeting (there's a phrase we're not used to writing). Republican co-chair Sen. Bryan King announced that he'd requested that Leg. Audit release its findings on the Medicaid program, slated to be released in March as part of the DHS audit, this week instead.

There are reasons to be suspicious about the report, which many believe to be politically motivated, and suggestions that King has tried to influence the audit and use it as a political stunt. DHS released a furious response, complaining of "alarming flaws," which wouldn't surprise us, but also suggests that the audit at least looks bad.

The good news is that once released, we'll actually have something to debate, instead of unspecified anecdotes of waste (a "gut" feeling, as House Speaker Davy Carter described it). But politically, it almost doesn't matter whether the audit findings are as fishy as DHS says. The conversation will shift, and Republican lawmakers hoping to block expansion are giddy about poking holes in the existing system rather than talking about expanding. It certainly feels like this was carefully rolled out this week, as Republicans spread rumors about shocking waste uncovered in the report, then tweeted and re-tweeted reports of those rumors, then Carter went out of his way to offer a preemptive defense of Leg. Audit. (Rumors that Carter may run for governor cast another dark cloud on expansion — can't win a state-wide Republican primary unless you're anti-Obamacare).

On the plus side for expansion proponents, some consensus emerged that a "circuit breaker" would be a potentially powerful tool to avoid sticking the state with bigger costs than advertised down the road if the feds change the match rates (leaving the Republicans only with Sen. Ceclie Bledsoe's bizarre logic: better to never give coverage than possibly some day take it away). And the early returns on the Medicaid program's Payment Improvement Initiative look good, with the shortfall less than half what it was, suggesting that the program may be well on the way to cutting costs to offset fears of the costs of expansion down the road.

Still, the unified Republican front to change the subject to waste leaves the Expand-o-meter very bearish this week, as we dip below 40 percent.

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