If the Supreme Court follows the election returns, as one of my Political Science professors taught me, the Congress even more so.
A dozen GOP members of the House are retiring; they will be more likely to follow the path of Senators Corker and Flake and break with President Trump. Others will join their departing ranks.
As Robert Mueller draws closer to the President, these Republicans will move further away.
The Trump Administration announced on Tuesday what it called ‘a new day for Medicaid,’” the New York Times reported yesterday, “telling state health officials that the federal government would be more receptive to work requirements and other conservative policy ideas to reshape the main government health program for low-income people.”
In Maryland, we adopted a requirement that welfare applicants and recipients be screened for drug use. I worked on this with a health expert and a Republican colleague.
I have contacted a lobbyist on social welfare issues to discuss our strategy for Medicaid’s “new day.”
The fate of Obamacare, and with it Medicaid, is one of those Washington issues that will affect Maryland.
States could get less money but more freedom in running their Medicaid programs if the Congress decides to block grant the program.
That’s what happened under federal welfare reform.
Since Fiscal Year 2011, Maryland’s program has run a deficit. The ending balance over the last four years has averaged minus $15 million.
Several Republican governors are devising proposals that would require many Medicaid recipients to have a job, participate in job training, or perform community service, according to the New York Times.
When we adopted a drug testing requirement as part of Maryland’s welfare reform, I asked Peter Beilenson, then the Baltimore City Health Commissioner, for his advice.
I did so again this week.
Peter responded: “I’ve come to the conclusion that work requirements for vital social service programs are, most of the time, short-sighted, particularly with medical services. Imposing work requirements for Medicaid will push many so-called able-bodied individuals off the Medicaid rolls due to inability to find jobs (mentally ill, substance users, under-qualified for any livable wage jobs, etc) and these people who lose Medicaid coverage will cost far more due to uncompensated care for untreated chronic conditions than if they had stayed on Medicaid.”
A big number and two words.
If the Congress reduces the federal portion of the cost of the expansion of Medicaid coverage under Obamacare, the cost to Maryland would be $1.27 billion.
For more than 30 years, Maryland’s all-payer system has meant that all patients pay the same rate for hospital care, whether they have private insurance or are on Medicare or Medicaid. If a person doesn’t have health coverage, the rates increase for those with insurance to cover that uncompensated cost of care.
If the federal government were to end its contract with us for this all-payer system, $2.3 billion in annual federal payments to Maryland hospitals would be jeopardized.
That’s $3.57 billion. Per year.
The need to provide for that health care will not disappear. Nor will the need to compensate health care providers.
The two words: special session.
No one expects the Congress to “repeal and replace” Obamacare before we adjourn in April.
A gap in funding of this magnitude – and its effect on the provision of health care, would need to be addressed immediately.
And in a bipartisan manner.