Expanding Medicaid not the answer: Lessons from Arkansas and Virginia

Expanding Medicaid not the answer: Lessons from Arkansas and Virginia
Bruce Westerman

Citing more than $200 million in “waste, fraud and abuse” in Virginia’s Medicaid program, Republican leaders say expanding the program now would be throwing good money after bad. Like lawmakers did in Arkansas.

Still, state Democrats and a handful of Republicans in the state Senate are pushing hard and fast to extend the indigent-care program to 400,000 additional lower-income Virginians this year.

Arkansas House Majority Leader Bruce Westerman said he saw the same hurry-up tactics in his state, with subsequent “buyer’s remorse.”

We just put another layer of complexity on top of a broken system,” Westerman said in a conference call with reporters on Tuesday.

Westerman’s Virginia counterpart, Republican Kirk Cox, said the House received “a three-page summary and a PowerPoint presentation” touting the benefits of a “private expansion” of Medicaid.

“It’s a mirror of the Arkansas plan,” he concluded.

The so-called “private option” in Arkansas “confuses people,” Westerman said. He noted that the rush to passage in Little Rock was “reminiscent of then-U.S. House Speaker Nancy Pelosi saying Congress had to pass [Obamacare] to find out what’s in it.”

On Tuesday, the Arkansas House of Representatives reversed course and voted to halt the program, the Wall Street Journal reported. “It was sold as free money from D.C., but it’s not free, and strings are attached,” Westerman said.

Gary D. Alexander, Pennsylvania’s secretary for public welfare from 2011 to 2013, independently warned that complex federal formulas for determining federal matching funds “introduce a strange dynamic” to expansion. Writing in the Washington Times, Alexander observed:

States will see a relative reduction in the federal match for the most vulnerable and needy Medicaid populations, but a relative gain in the match for the newcomers, namely the able-bodied living above the poverty line.

With the 2014 Virginia General Assembly in its last 30 days, hospital and Virginia Chamber of Commerce lobbyists have joined Democratic Gov. Terry McAuliffe in prodding lawmakers.

The GOP-controlled House asked that the Medicaid Innovation and Reform Commission finish its analysis first. MIRC is scheduled to finalize its report by year-end. Questioning the Medicaid-expansion agenda — with start-up costs pegged at $24 million to $30 million — Cox said, “There are a lot of assumptions we don’t think will come true.”

One thing that is certain, however, is that the existing program is rife with problems. Former Attorney General Ken Cuccinelli’s Medicaid Fraud Unit recovered more than $200 million in ill-gotten benefits and payouts, said state Sen. Tom Garrett, R-Louisa.

MIRC Vice Chairman Steve Landes cautioned that proponents’ hoped-for flexibility in administering a “private” Medicaid program does not exist.

“Waivers are temporary. Expansion is permanent,” the Republican said.

Cox discounted the notion that the business community is united behind immediate Medicaid expansion, stating that “the National Federation of Independent Businesses is against it.”

House Appropriations Chairman Chris Jones added that other business leaders, including executives with other chambers of commerce, want the state to fix its Medicaid program before expanding it.

Read more by Kenric Ward at Watchdog.com.


Kenric Ward

Kenric Ward

Kenric Ward is a national correspondent and writes for the Texas Bureau of Watchdog.org. Formerly a reporter and editor at two Pulitzer Prize-winning newspapers, Kenric has won dozens of state and national news awards for investigative articles. His most recent book is “Saints in Babylon: Mormons and Las Vegas.”

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