I am starting to read through the Center for American Progress’s Medicare Extra proposal. It proposes to create a huge comprehensive public option with multiple buy-in points. It also replaces other government programs like CHIP and Medicaid with Medicare Extra. Most of the financing is federal. There is something that strikes me as odd with the Medicaid program:
Medicaid and the Children’s Health Insurance Program (CHIP) would be integrated into Medicare Extra with the federal government paying the costs….
States would be required to make maintenance-of-effort payments to Medicare Extra equal to the amounts that they currently spend on Medicaid and CHIP.22 ….
And I mean that from a policy angle and a political angle. Why does CAP want to charge states for a portion of low income health care expenses? From a policy angle, I am scarred by the 2008-2010 Great Recession. I want as many automatic stabilizers that are not tied to balance budget requirements as possible. One of the big chunks of the stimulus bill was an enhanced federal Medicaid payment rate which allowed states to not cut budgets as deeply as they normally would have. We don’t want 50 Mini-Hoovers squeezing out Medicaid.
Secondly, and this is a political angle, state level buy-in to a proposal like this is probably likely to be a whole lot higher when the Feds could tell a state “You know, don’t worry about low income health care programs, we’ll take care of it and you can use that $3 billion a year on schools, roads, tax cuts or hookers and blow; your choice”
The support of governors was critical in the summer of 2017 because they saw their states directly benefit from the ACA’s Medicaid expansion. Taking away a problem will get a lot of governors’ to buy in as well.
I’m still reading and ruminating on the rest but this issue just seemed out of place with the rest of the document.