Medicaid, which is a federal/state partnership to provide health insurance coverage for low-income Americans, came into being at the same time as Medicare. The share of the cost of the program paid for by states varies based on a formula that takes into account the income levels of the particular states. Louisiana, because we are a state with high levels of poverty, has historically had one of the most favorable federal/state cost sharing ratios. Medicaid plays a crucial role in the state’s health care delivery system.
As the program nears the anniversary of 50th year of its enactment, Republicans have launched an assault on the program, seeking to change the funding mechanism with the ultimate goal of eliminating the program or its funding, what ever comes first.
Paul Ryan’s Attack on Medicaid
Wisconsin Republican Paul Ryan, Mitt Romney’s choice as his vice presidential running mate, has issued the most radical plan for restructuring Medicaid. It has been approved by his colleagues in the U.S. House of Representatives on a straight party-line vote.
Ryan’s plan calls for Medicaid to be immediately converted to a block grant from the federal government to the states and would eventually leave the operation of the program in the hands of the states.
Unlike the Affordable Care Act which expands Medicaid as a means to reduce the number of uninsured adults, Ryan’s plan does not seek to bring more uninsured into the program. Republican health care policy leaders like Ryan have now abandoned the idea of doing anything about the central force driving the health care crisis — the growing number of people without health insurance or the ability to pay for the care they need.
By converting Medicaid to a block grant program, Ryan’s plan would undermine the financial viability of the program and abandon any federal role in the provision of health care services or access to them by the poor and disabled.
Louisiana Republicans’ Attack on Louisiana Medicaid
Louisiana’s Medicaid program came under a concerted attack from a surprising source in early summer. Republican members of Louisiana’s congressional delegation stood idly by (at best) or actively conspired (at worst) to inflict a $651 million hit on Louisiana’s Medicaid program, a matter of days into the state’s new fiscal year which began on July 1.
Primary responsibility for the resulting carnage must lay at the feet of Senator David Vitter who, as a member of the Transportation Bill conference committee, was Louisiana’s only representative on that small committee which determined which provisions were included or left out of the final version of the bill. While Senator Vitter claimed credit for all other provisions in the bill that affected Louisiana, he was strangely silent on the Medicaid clawback.
The clawback refers to the federal government’s effort to recoup money overpaid to Louisiana under an agreement originally worked out by Senator Mary Landrieu, the Obama administration, and the Jindal administration in 2010. Louisiana knew it would have to pay the money back, it was just not sure when.
Republicans on the Energy & Commerce Subcommittee wanted it paid back this year, with the opportunity to score points against Senator Landrieu and President Obama.The committee should have been aware of the harm they were doing because Louisiana has two Republican among its members — First District Congressman Steve Scalise and Sixth District Congressman Bill Cassidy. Neither apparently voiced concerns about the impact of mid year cuts on the state’s health care budget. Cassidy was a doctor at Earl K. Long Hospital, one of the state’s public hospitals run by LSU Health Science Center.
Governor Jindal was even less helpful. Senator Landrieu, in at least 15 conversations between her chief of staff and Commissioner of Administration Paul Rainwater, tried to get the Governor engaged on the issue by calling Speaker John Boehner — to no avail. Jindal never called Speaker Boehner. The Governor let the federal budget axe fall without lifting a finger.
Jindal and his allies are now citing the crisis they helped cause serve as the justification for dismantling of the state’s public health hospital network. With another round of cuts likely this year as well as another piece of the clawback, Jindal and his allies are seeking to close as many of those hospitals as they can before 2014; that’s when the main provisions of the Affordable Care Act bring an influx of new health care dollars into the state. Those dollars would put the LSU hospitals on the path to sustainability with reduced dependence on state dollars.
When have so many members of the state’s own congressional delegation stood idly by and allowed so much harm to be inflicted on Louisiana as have Senator Vitter and Congressmen Scalise and Cassidy? What other Louisiana Governor has refused to intervene with Congress to try to prevent harm from being inflicted on this state as Jindal did with the Transportation Bill?
Extremist Republicans like Jindal, Vitter, Scalise and Cassidy do not care about governing. In fact, they don’t seem to want government to work at all. Instead, they appear to derive a perverse pleasure in disrupting the lives of those that are not considered allies. The havoc that the Medicaid clawback is inflicting on patients, families, institutions and communities does not appear to phase them whatsoever. It’s only health care for other people.
Tomorrow: The Republican Attack on Private Health Insurance.
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Originally published: Aug 14, 2012