Louisiana Gov. Bobby Jindal, head of the Republican Governors Association, has called for a meeting of governors with President Obama over the issue of Medicaid.
Writing in a January 28th oped in The Washington Post, Jindal made the case that the Medicaid expansion mandated by Obama’s health care law would not serve poor Americans well, instead forcing them into a system which is already overburdened.
“Medicaid operates under a 1960s model of medicine, with inflexible, one-size-fits-all benefits and little consumer engagement and responsibility. Expanding the entitlement program as it stands would further cement a separate and unequal tier of health coverage,” Jindal writes, noting that “A number of Republican governors have asked to meet with President Obama to discuss their solutions, but the White House has ignored these requests.”
Jindal also lays out his approach to Medicaid reform:
First, the process to determine eligibility should be simple, accurate and fair. There are far too many complicated categories of Medicaid eligibility. The process should be easier for consumers to navigate and for states to administer. States should have the flexibility to set eligibility standards that make sense for residents, instead of the rigid, one-size-fits-all approach dictated by Washington. For any expansion, there must be straightforward rules to identify who is newly eligible for Medicaid vs. those who would have traditionally been eligible. Our country cannot afford billions of dollars in payments on untested methodologies.
States should be allowed to design their programs to promote value and individual ownership in health-care decisions. This includes using consumer-directed products, flexible benefit design, and reasonable and enforceable cost-sharing requirements. States must be freed from decades-old rules that are no longer relevant to 21st-century health care. For example, just like those of us who have employer-sponsored coverage or Medicare, Medicaid recipients shouldn’t have free access to hospital emergency rooms for routine care. When individuals have no skin in the game, they are less likely to consume care responsibly.
States should be able to make use of their private health insurance market through their Medicaid eligibility levels, program design and ability to offer premium assistance. Currently, states are prevented, until 2019, from moving youths enrolled in their Children’s Health Insurance Programs to their parents’ insurance if the coverage was purchased in an exchange. It doesn’t make sense for family members to be in different coverage programs or for the federal government to crowd out and replace private coverage with a government-run program. Furthermore, states should have the ability to grant “premium assistance” for Medicaid-eligible individuals at any income level to buy into the health insurance market.
Finally, the Department of Health and Human Services (HHS) should streamline Medicaid financing and improve the process to give states more flexibility, coupled with greater accountability. The process by which states negotiate for flexibility, called “waivers,” is broken. Federal officials should have greater accountability for timely review of waiver applications. In particular, waiver applications based on those already approved in other states should be fast-tracked. HHS should allow states to opt in to a more flexible long-term-funding arrangement, allowing them to design programs that best meet residents’ needs, rather than requiring the same package of services for every individual. At the same time, federal and state officials could agree to greater accountability for improvements in health outcomes, not just processes.
Jindal is not alone. States continue to have significant concerns about Medicaid funding and whether it will continue to match the high levels of initial support offered in future years — and even without that support, Obamacare will require significant tax increases to match the federal dollars. To this point, only two Republican-led states have said they will accept the Medicaid expansion dollars under Obama’s law.