By Jocelyn Guyer
The new Chairman of the Energy and Commerce Committee invited three of the nation’s governors to testify at a hearing entitled “The Consequences of Obamacare: Impact on Medicaid and State Health Care Reform.” As the title of the hearing suggests, the event was heavy on posturing and politics and light on illuminating substance. Governor Haley Barbour of Mississippi, in particular, was in fine form, arguing forcefully for a Medicaid block grant at Tuesday’s hearing. On his swing through Washington, he delivered a series of zingers that served to disparage Medicaid, including conjuring up the image of beneficiaries driving up to pharmacy windows in their BMWs and refusing to make co-payments that harkened back to the fictitious “welfare queens” of the Reagan era. (I’m sure I don’t need to remind Say Ahhh! readers, that this is about as realistic as Anne Hathaway hosting the Academy Awards in sweat pants with no wardrobe changes).
While his delivery wasn’t quite as jovial, Representative Henry Waxman, ranking member of the committee, did ask Governor Barbour the key question – who is it that Mississippi would like to have the flexibility to cut off? The state’s low-income children (who won’t save much money because they are inexpensive to coverage) or its seniors and people with disabilities (who do cost a lot of money, but desperately need care)? Interestingly, and here we actually get to a touch of substance, Governor Barbour said that he didn’t want to cut anyone off, and instead, said he controlled his Medicaid costs by, among other things, requiring a face-to-face interview once a year. When asked by a Member of the panel about whether or not the MOE would actually prohibit him from using this roadblock to coverage, the Governor had to admit that it does not prevent him from doing so since it was in place when ACA was signed into law.
The fact that Governor Barbour is so proud of his out-dated strategy for denying kids coverage that he was willing to spend his limited time testifying before Congress about something that doesn’t impact his state is somewhat puzzling. Is it an effort to encourage other states to follow his lead by employing this draconian practice if the stability protections are rescinded? As we talked about in more detail in our recent paper on the impact of rescinding the stability protections, states don’t often directly eliminate coverage for children – too politically unpopular – but in the last recession, 23 states did set up backdoor roadblocks to coverage by adding paperwork barriers to enrollment.
Governor Patrick of Massachusetts made a strong pitch for the extensive flexibility already in the health reform law and gave practical information on how a similar model has worked in Massachusetts. He highlighted that the state now is covering 98 percent of people – and 99.98 percent of kids – and noted that Massachusetts has managed to successfully manage health reform while at the same time the Commonwealth invested record-high levels of funding into its education system. The major challenge now for the state is tackling rising private health insurance premiums, which Governor Patrick pointed out is an issue throughout the country and something the Affordable Care Act provides the states the tools to deal with more effectively.
Governor Herbert of Utah also made a strong pitch for more state flexibility, and talked in detail about his positive feelings about his state’s exchange. Unfortunately, though, no one asked him for the hard data on how many people it serves and how effective it has been in addressing the goals of reducing costs and covering uninsured people in Utah. It will take another hearing, perhaps on a less politically overheated day, to untangle the impact of the Utah exchange.