January 18 2011
30 Ideas for 30 Days: Day 9
Nicole Kurokawa Neily
As of today, 27 states have joined, or are in the process of joining, lawsuits against the federal government over Obamacare.
One of the major concerns of states: the unfunded mandates that states will be forced to shoulder, like adding an additional 16 million people to Medicaid (a program that’s less-than stellar to begin with.) Such a move would further stretch states’ already-thin budgets to the breaking point, as stated in a recent letter by several of the nation’s governors.
Alas, one consequence of this situation is that those most likely to suffer will be the nation’s poorest residents who are on Medicaid. Access to quality care and innovation are almost certain to be sacrificed in lieu of meeting bare federal guidelines, as states struggle to stay afloat.
Suggestion #9: Block grant Medicaid funding to states.
Sure, there’s been a token effort by the federal government to shoulder some of the financial burden by covering some states’ expansion costs – but this money comes with significant strings attached, and it won’t last forever. In turn, states forfeit a considerable amount of autonomy – and that, unfortunately, WILL last forever.
As the Congressional Budget Office noted in its March 20, 2010 analysis of the final health care reform bill, “Under current law, states have the flexibility to make programmatic and other budgetary changes to Medicaid and CHIP. CBO estimates that state spending on Medicaid and CHIP in the 2010-2019 period would increase by about $20 billion as a result of the coverage provisions.”
Block granting Medicaid funding to states will provide them with the flexibility to account for local and regional differences, while avoiding the “one size fits all” arrogance that so often permeates federal policy. With proper oversight, block grants can be a useful way for states to try out different policies and compare efforts – hopefully, leading to better outcomes across the nation.
States should be encouraged to experiment with their Medicaid programs, with the end goal being to cover as many people as possible while still providing high-quality care. After all, telling someone that they have health coverage without giving them actual access to care is deceptive, and can sometimes lead to tragic consequences.