The Republican governors appearing before the Energy and Commerce Committee this morning rejected calls for opting out of the state-federal Medicaid program, an idea initially floated by the Heritage Foundation and temporarily embraced by Texas Governor Rick Perry (R). “I can’t imagine Mississippi opting out of Medicaid. We’re a poor state and it’s an important program,” Gov. Haley Barbour (R-MS) said. Gov. Gary Herbert (UT) agreed, “we have no plans to opt out of Medicaid,” he added.
The two Republican witnesses — Massachusetts Governor Deval Patrick was the sole Democrat on the panel — also largely dismissed President Obama’s endorsement of an amendment that would allow states to meet certain coverage and cost benchmarks, suggesting that the measure provides faux flexibility. Bot Barbour and Herbert complained that they would still have to comply with the yet-to-be defined minimum benefits package requirement:
BARBOUR: “The devil is in the details, but the thing that concerns me is that the things that are in the statute, we’re told, the states would still have to do….and if we get saddled with a standard benefits package like Massachusetts, that’s why our employers will drop coverage. Because their premiums will skyrocket. So if it doesn’t give us relief from that or similar things, it’s not much help.”
HERBERT: “How flexible is flexible? It’s clearly not absolute flexibility. This is not a block grant, do as you see fit. It is a maintenance of effort still required. The essential benefits package stays the same, the eligibility for Medicaid still is there. So if you get the outcomes that we say to you state, then we got flexibility and that really is not flexibility.”
As Politico’s Sarah Kliff points out, Herbert was far more receptive to the amendment yesterday, telling Kliff that the president’s speech was a “step in the right direction.” “I’m hopeful it’s going to lead better discussions of understanding about flexibility,” he said yesterday.
His positioned hardened this morning, but it’s no less accurate. Under the law, states can apply for a whole host of waivers from the Medicaid program and Part I of subtitle D of the Affordable Care Act, the establishment of a qualified health plan — which includes the essential health benefits requirements.
The larger point here, however, is that if conservative lawmakers really had a plan to expand access to insurance or lower health care costs, they would presumably be proudly touting these ideas and if they didn’t fall within the confines of the innovation mandate, the governors would be requesting waivers from the federal government (as some progressive states are now doing in an effort to enact single-payer health care reform). But during today’s hearing Republicans paid lip service to the importance of flexibility but did not detail what they planned to do with that new found freedom or how those ideas can meet the coverage or cost benchmarks set forward in the Affordable Care Act.