Governors Concerned About Reform Efforts
by Deacon Blues
One consistent element in the various proposals is an expansion of state Medicaid programs to cover uninsured adults families. Democrats and Republicans alike support the idea because it builds upon a vehicle already out there (Medicaid) and allows some degree of state input into the process.
The underlying flaw in the idea however is that the states are already broke, and handing them any new obligation (Medicaid is a joint federal/state program) and possible unfunded federal mandates down the road is a nonstarter for Democratic and GOP governors alike:
Although many governors said significant change in how the nation handles health care was needed, they said their deep-seated fiscal troubles made it a terrible time to shift costs to the states. With the recession draining states of tax revenues even as their Medicaid rolls are surging, the National Governors Association projects that states will face aggregate deficits of $200 billion over the next three years.
Each of several health care bills coursing through Congress relies on a large increase in eligibility for Medicaid, the state and federal insurance program for the poor, as one means of moving toward universal coverage.
Because the states and the federal government share the cost, any increase in eligibility levels, benefits or payments to doctors would impose new burdens on the states unless Washington absorbs them. In at least one of several bills circulating in Congress, the states would eventually pick up a share of the new costs, and the governors fear they cannot count on provisions in other bills that they will not bear costs.
What the governors want of course is input and control, but with little financial obligation to pay for it. They would love it for the feds to pick up the whole tab, but their opposition isn't without merit. Launching a health care reform effort in the midst of the financial wreckage left behind by George W. Bush will bedevil Barack Obama for the remainder of his first, and possible second terms.