Republicans Push Plan to Renege on Medicaid Promise

WASHINGTON, DC - AUGUST 01: House Ways and Means Committee members U.S. Rep. Paul Ryan (R-WI) (R) and U.S. Rep. Tom Price (R-GA) visit before a committee hearing in the Longworth House Office Building on Capitol Hill August 1, 2013 in Washington, DC. During a hearing titled, 'The Status of the Affordable Care Act Implementation,' the committee questioned representatives from the Centers for Medicare and Medicaid Services and the Internal Revenue Service responsible for implimenting the ACA. 
National Journal
Sarah Mimms
Nov. 17, 2013, 7:38 a.m.

Dur­ing the nasty cam­paign for Vir­gin­ia gov­ernor last month, House Budget Com­mit­tee Chair­man Paul Ry­an, R-Wis., tried to poke a hole in Demo­crat­ic can­did­ate Terry McAul­iffe’s pledge to tap the full fed­er­al fund­ing prom­ised to states for ex­pand­ing their Medi­caid pro­grams.

“The no­tion that the fed­er­al gov­ern­ment is go­ing to keep match­ing Medi­caid spend­ing at this level is a no­tion that is just a faulty premise. It’s go­ing to get cut,” Ry­an said on a con­fer­ence call with Re­pub­lic­an gubernat­ori­al can­did­ate Ken Cuc­cinelli in late Oc­to­ber.

Now Ry­an’s right-hand man on the Budget Com­mit­tee, Rep. Tom Price, and oth­er House Re­pub­lic­ans are push­ing a plan that would en­sure those fed­er­al dol­lars do not come through.

Price, a Geor­gia doc­tor, brought up the is­sue dur­ing a meet­ing of the budget con­fer­ence com­mit­tee on Wed­nes­day, ar­guing that by for­cing states to pay for at least a por­tion of their ex­pan­ded Medi­caid pro­grams, Con­gress could mit­ig­ate some of the se­quest­ra­tion cuts — a key goal for Demo­crats on the com­mit­tee.

Cur­rently, the fed­er­al gov­ern­ment has prom­ised the states that it will kick in 100 per­cent of fund­ing for a Medi­caid ex­pan­sion over the first three years. After that, the gov­ern­ment will pay for at least 90 per­cent of the pro­gram in­def­in­itely. So far, 25 states and the Dis­trict of Columbia have ex­pan­ded the pro­gram un­der those terms, while an­oth­er four are con­sid­er­ing an ex­pan­sion. McAul­iffe, who nar­rowly de­feated Cuc­cinelli on Nov. 5, has made it a top pri­or­ity when he as­sumes Vir­gin­ia’s gov­ernor­ship in Janu­ary.

Price sug­ges­ted Fri­day that the fed­er­al con­tri­bu­tion should be dropped to 90 per­cent im­me­di­ately. While the is­sue is not cur­rently un­der “of­fi­cial” con­sid­er­a­tion in the budget con­fer­ence com­mit­tee, he said, many House Re­pub­lic­ans are dis­cuss­ing such a pro­pos­al.

“Many states didn’t ex­pand,” Price told Na­tion­al Journ­al Daily. “So all cit­izens are sub­sid­iz­ing the states that ex­pan­ded. So the fair thing to do, from my per­spect­ive and many in­di­vidu­als’ per­spect­ive, is to have the same, at least the same “¦ 10 per­cent match by the states.”

Such a move would pull the rug out from those gov­ernors who have already agreed to the ex­pan­sion, and it would have an out­size ef­fect on Demo­crats. Sev­en­teen of the 25 states that have ex­pan­ded are con­trolled by Demo­crat­ic gov­ernors, in­clud­ing in Rhode Is­land, where Gov. Lin­coln Chafee re­cently changed his party af­fil­i­ation from in­de­pend­ent.

The Obama ad­min­is­tra­tion has bent over back­wards to re­as­sure states that they can count on full fed­er­al fund­ing. The ad­min­is­tra­tion went so far as to change its po­s­i­tion and op­pose Medi­caid cuts it had pro­posed — a move ex­pli­citly de­signed to send a sig­nal to states that were wor­ried about the fed­er­al com­mit­ment to Medi­caid fund­ing.

The GOP pro­pos­al to renege on the com­mit­ment isn’t new. Re­pub­lic­ans have been say­ing for months that the full fed­er­al fund­ing was un­likely to come through, while the con­cern about the gov­ern­ment’s com­mit­ment to its prom­ise was a key ar­gu­ment in many states’ de­cisions not to ac­cept the ex­pan­sion.

Asked wheth­er Re­pub­lic­ans had set them­selves up for a self-ful­filling proph­ecy, giv­en their earli­er warn­ings that states shouldn’t rely on the fed­er­al fund­ing, Price said: “We’re $17 tril­lion in debt. At some point you’ve got to get fisc­ally re­spons­ible.”

The pro­pos­al is an­oth­er in a series of Re­pub­lic­an ef­forts to un­der­mine as­pects of Pres­id­ent Obama’s health care law.

“Re­pub­lic­ans try­ing to scare people across the coun­try with lies about the Medi­caid ex­pan­sion would be a bit more cred­ible if they didn’t come back to D.C. and fight to shift the costs onto states and fam­il­ies them­selves,” one Sen­ate Demo­crat­ic aide said Fri­day.

Demo­crats on the budget con­fer­ence com­mit­tee strongly op­pose Price’s idea, say­ing the is­sue is a non­starter. “That’s not go­ing any­where,” said House Budget Com­mit­tee rank­ing mem­ber Chris Van Hol­len, D-Md., on Fri­day.

“Rather than try and re­duce the amount [the fed­er­al gov­ern­ment is giv­ing], those states that are not al­low­ing people to par­ti­cip­ate should al­low them. Right now, they’re deny­ing 5 mil­lion Amer­ic­ans af­ford­able health care. Five mil­lion people. And they some­how want to be re­war­ded for that,” Van Hol­len ad­ded.

Asked wheth­er he thought he could get sig­ni­fic­ant num­bers of Demo­crats on board with the idea, Price shook his head. “Oh, prob­ably not…. Their abil­ity to em­brace pos­it­ive solu­tions is lim­ited,” he said, laugh­ing.

But the dis­cus­sion alone could con­vince some of the states still con­sid­er­ing an ex­pan­sion to back away from the idea. “I think they join at their own per­il. There’s no guar­an­tee that that money’s go­ing to be there,” Price said.

“What I’m try­ing to do is what’s fair and ap­pro­pri­ately rep­res­ent my con­stitu­ents, yeah,” he said.

Sam Baker contributed contributed to this article.
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