To hear Republicans tell it, America's governors have all kinds of creative plans for what to do with Medicaid, which is funded jointly by state and federal governments, if only they could be released from Washington's shackles to get all innovative. As Suzy Khimm explains, "Republicans in both houses introduced bills on Tuesday that would eliminate federal regulations that prevent states from trimming their Medicaid rolls or erecting new barriers to enrollment." Now that's how you save money: throwing people off Medicaid, or making it next to impossible for them to get it in the first place. Innovative!
But Rep. Phil Gingrey kind of gives up the game here: "'Take the handcuffs off the governors,' Gingrey (R-Ga.) said at the bill's unveiling on Tuesday, arguing that current law prevents the states from 'ferreting out waste, fraud, and abuse, finding out if someone's falsified information on income … maybe even if they're illegal immigrants.'" The primary objection here isn't budgetary; it's moral. Many conservatives feel that poverty is a moral failing, and if you're getting help from a government program, you're probably some kind of scamming welfare queen sucking off people who work for a living, getting a benefit you don't deserve.
Medicaid really has no friends. Even people who support it admit that it's inadequate. But the particular way it's inadequate is that it's stingy. Medicaid reimbursement rates are extremely low, which means doctors hate it (and which is why many doctors refuse to accept Medicaid patients). It's not like Medicaid is paying for lavish spa vacations or anything. So if you want to squeeze money out of the program, the way you do it is by giving coverage to fewer people. And unlike Medicare, the constituency of Medicaid is largely poor, which means they have little power to punish the politicians who go after it.
If governors have some terrific, innovative plans for Medicaid, let's hear about them. In the meantime, when you hear Republicans talking about "flexibility" in Medicaid, what they're talking about is the flexibility to toss people off their coverage.
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