At the heart of Paul Ryan?s plan for Medicaid is a tectonic shift in the federal government?s authority over the entitlement. In the Wisconsin Republican?s proposal to ?block grant? the program, states would receive a fixed amount of federal money for Medicaid ? and much greater leeway to change the program?s structure ? rather than an uncapped, formula-based contribution with many strings attached. The Ryan plan, along with other more incremental GOP proposals, would fundamentally alter the federal government?s role in structuring, overseeing, and administering Medicaid, abdicating much of this authority to the states.
In the face of such challenges, the Obama administration is quietly taking steps to reassert and strengthen the federal government?s authority over Medicaid. A few weeks ago, the Centers for Medicare and Medicaid Services rolled out a proposal that could make it more difficult for states to cut rates for doctors, hospitals, and other providers in Medicaid?one of the many ways that cash-strapped statehouses are trying to save money.
The proposed rule requires states to implement new standards by 2013 ?to review access to Medicaid annually, based on enrollee needs, the availability of health professionals and medical care, and the use of services,? reports American Medical News. The administration will also require state officials to make the results of these evaluations public, in hopes of holding states more accountable for changes they make to Medicaid and to dissuade them from squeezing large numbers of Medicaid beneficiaries out of the program. ?The federal government is asserting its role as steward of the program,? says Peter Harbage, a health-care consultant and former Clinton administration official.
Some state officials are already bristling at the proposal, saying the new requirements are onerous and needlessly intrude on state authority. ?It?s just an enormous amount of work,? Washington state?s Medicaid director told American Medical News, arguing that the rules would spur more lawsuits over provider rates. But the Obama administration isn?t just standing up to states in asserting its role in overseeing Medicaid ? it?s also trying to prevent private individuals from challenging the program.
Last week, the Department of Justice filed a friend-of-the-court brief at the Supreme Court that opposed the ability of private individuals to sue states for lowering Medicaid provider rates and choking off access to the program. Weighing in on the case, Douglas vs. Independent Living Center of Southern California, Obama?s solicitor general asserted that it was the responsibility of the Department of Health and Human Services, not individuals, to ensure that states are complying with Medicaid?s promise of equal access to care. Essentially, Obama officials are affirming that federal officials ?are better equipped than judges to balance that goal [of equal access] with other policy objectives, like holding down costs,? explains the New York Times? Robert Pear.
Some progressive thinkers are worried that the White House?s position could strip away protections from Medicaid providers and beneficiaries ? removing their ability ?to ensure that states and the federal government are complying with the requirements of Medicaid,? Edwin Park, vice president of health policy at the left-leaning Center for Budget and Policy Priorities, told me. But in the larger debate over Medicaid?s future, many of the same critics have strongly defended the federal government?s role in overseeing the program, fending off challenges from states? rights advocates. Such positions could undercut their case for being able to intervene as private individuals in Medicaid oversight.
That being said, the Obama administration isn?t going so far as to push for federalizing Medicaid, as some policy analysts have proposed as a means of relieving state budgets and making the program more efficient. For the time being, Medicaid will remain a federal-state partnership. And while the White House has been publicly trying to emphasize the flexibility that states still retain in Medicaid, it?s also working behind the scenes to underscore the ?federal? part of that equation.
Suzy Khimm is a staff reporter in the Washington bureau of Mother Jones.
Source: http://feeds.washingtonpost.com/click.phdo?i=c13e57070594b98287ac791cba001af4
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