Senator Mark Green and Lindsay Boyd Writing For The Washington Examiner…
Tennessee said no to Obamacare so that it could lead the way in real health reform. Now we’re asking Washington for some backup.
Recently in Tennessee, we partnered to file a joint resolution calling on Congress and the Trump administration to reward the Volunteer State for resisting an unsustainable Medicaid expansion under the Affordable Care Act.
Unlike many of our peer states, Tennessee made the politically difficult choice to protect our state’s most vulnerable, while likewise seeking alternative, market-based solutions that provide greater access to quality and affordable healthcare for all Tennesseans. As the ACA repeal and replace process continues to develop, we ask that the federal government acknowledge the hard work that states like Tennessee have done to plow our fields and make ready the fertile ground for reimagining Medicaid in a post-Obamacare world.
Since the passage of the ACA, 31 states have chosen to dump thousands of able-bodied, working-age adults without children onto Medicaid rolls that are already failing to meet the needs of the most vulnerable.
The federal government matches 100 percent of a state’s cost of covering these new additions to Medicaid, while the rate for traditional Medicaid populations ranges from a floor of 50 percent to a ceiling of 73 percent depending on a state’s wealth. One need not be a mathematician to see the perverse incentives created for states to prioritize the expansion population of able-bodied adults over traditional, more vulnerable Medicaid enrollees.
With millions now added to state Medicaid populations under the ACA, this makes for a messy job that Congress simply can’t untangle overnight. But what about states like Tennessee that said “no” to this failing scheme and are ready to embrace a new frontier in the way we manage healthcare?
President Trump must understandably work with those expansion states to construct an off-ramp from the ACA that doesn’t punish patients for states’ bad decisions. But he also owes the non-expansion states the ability to implement effective, free market healthcare reforms while he attends to the expansion flock. Below are our list of grievances and reasons, as outlined in the Tennessee resolution:
- The Government Accountability Office has estimated that Medicaid spending will grow by 224 percent by 2032, “with the result that states will struggle to support their own Medicaid populations without meaningful control over the policy.”
- Medicaid funding arrangements fail to reward states based on patient outcomes.
- Welfare block grants have a proven record of success, giving states flexibility, a fixed state funding mechanism, and broad performance goals.
- Precedent for a block-grant type of approach already exists in the State Children’s Health Insurance Program, or SCHIP, giving states greater latitude in determining eligibility and a fixed funding formula for providing coverage to children.
- The Congressional Budget Office currently estimates that Medicaid accounts for more than a quarter of our federal deficit, and it’s growing. Medicaid is also the largest single program in Tennessee’s state budget, currently eating up more than one-third of our state tax dollars.
- The federal debt now reaches over $16 trillion, with a growth rate of over $1 trillion per year, with Medicaid serving as a major driver.
- Medicaid growth and expansion has done little to address the healthcare needs of patients, as documented in numerous peer-reviewed healthcare journals, including the Journal of the American Medical Association, Annals of Emergency Medicine, the Annals of Surgery, and others that found Medicaid patients to have worse overall healthcare outcomes than the uninsured.
We believe that non-expansion state legislatures across the country are poised to return greater care, access, and affordability to our Medicaid program through block-granted federal funds. In doing so, we can restore a federalist approach towards addressing our state’s healthcare needs and act as an incubator of market-based approaches to model for others.
Therefore, Mr. President and members of Congress, we submit to you our rallying cry for a return to federalism, letting Tennessee and other states set examples for the rest of the nation by stemming the unsustainable rising tide of healthcare spending for second-rate care. Let us begin this great work before us. The future starts now.
Lindsay Boyd is director of policy at the Beacon Center of Tennessee. Dr. Mark Green is a Tennessee State Senator (R-Clarksville).