Shots - Health News
5:10 pm
Mon February 25, 2013

Governors' D.C. Summit Dominated By Medicaid And The Sequester

Originally published on Mon February 25, 2013 5:31 pm

When the nation's governors gathered in Washington, D.C., over the weekend for their annual winter meeting, the gathering's official theme was about efforts to hire people with disabilities.

But out of the public eye, at the sessions for "governors only," the discussion reportedly was dominated by two more pressing issues of the day: whether or not to expand the Medicaid program as part of the Affordable Care Act; and the potential upcoming budget cuts set for the end of the week, known as the sequester.

President Obama even used his meeting with the governors at the White House on Monday to do a little lobbying.

"This morning, you received a report outlining exactly how these cuts will harm middle-class families in your states," he said, referring to a document released to the media Sunday night. "Thousands of teachers and educators will be laid off. Tens of thousands of parents will have to deal with finding child care for their children. Hundreds of thousands of Americans will lose access to primary care and preventive care, like flu vaccinations and cancer screenings."

The president urged the governors to meet with their members of Congress while they are in Washington "and remind them in no uncertain terms exactly what is at stake and exactly who is at risk."

Not all the governors, however, seemed convinced that the cuts would be such a terrible thing.

"It's hard for me to believe that America's going to be devastated by the federal government cutting its budget 2 or 3 percent," said Gov. Dave Heineman, R-Neb.

Rather, said Heineman, the president should consider taking a page from state executives' playbook.

"He should do like every governor in the country," he said. "We bring our legislature together; we solve this in a responsible way. The president is not leading right now. He's engaged in scare tactics, and that's the wrong way to go."

By contrast, the discussions over Medicaid, which had been highly partisan during the governors' meeting last summer in Williamsburg, Va., seemed to have taken on a far more conciliatory tone.

"I said in Williamsburg, after this election's over, these governors, the Republican governors that are claiming the Affordable Care Act is the end of the world, are going to recognize that it's a way for them to grow jobs and economic opportunities by giving lower income and middle income Americans access to health care," said Gov. Peter Shumlin, D-Vt. "And you're seeing them come on board, one after another."

Gov. C.L. "Butch" Otter, R-Idaho, said calling what's happening a shift in tone would be wrong. He said it's more a matter of playing the hand he's been dealt.

"We tried in court," he said. "We tried at the polls for a new president; we tried for a new Senate. We lost on all those fronts. So now it's time for us to recognize that one of the most important tenets of a republican form of government is the rule of law."

Idaho hasn't actually said yet if it will expand its Medicaid program — it's still negotiating with the Department of Health and Human Services. That was something else going on behind the scenes at the governors' meeting. HHS Secretary Kathleen Sebelius was meeting individually with governors to see what it would take to convince them to expand access to Medicaid. Under the law, the federal government has promised to pay 100 percent of the added Medicaid costs for the first three years, and at least 90 percent after that.

"They got a lot of coffee and a lot of water upstairs, and I think they're meeting with almost every governor," said Otter, who wouldn't comment on the outcome of his own meeting with Sebelius.

One thing that seems to be holding a lot of governors back from committing to the Medicaid expansion is the question of whether that money will really be there.

"Because of the budget mess here in Washington," Gov. Terry Branstad, R-Iowa, predicted to Politico over the weekend, "we're going to see at some point here in the next couple years, some kind of grand deal that's going to massively reduce federal spending, and they're going to dump the cost on the states. That's what they always do in Washington."

So far, only seven of the nation's 30 Republican governors have said they'll go ahead and expand Medicaid starting next year. But Gov. John Kitzhaber, D-Ore., says the most recent convert, Florida's Rick Scott, could change many more minds.

"First of all, he's a prominent governor," Kitzhaber said. "But he was also a very prominent opponent of doing what he's now decided to do, and I think that gives other people permission."

Indeed, even the Republicans who remain opposed to expanding Medicaid in their states are now being careful not to criticize their colleagues.

"I think all the governors agree that each governor has to do what they think is in the best interest of their state," said Gov. Mary Fallin, R-Okla. "We're respectful of other people's opinions."

And that may be the biggest change of all.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

AUDIE CORNISH, HOST:

For the past several days, governors from across the country have been meeting in Washington. Their annual gathering wrapped up today at the White House with President Obama and Vice President Biden. Now, two issues have dominated discussions among the governors: The upcoming budget cuts known as the sequester, and the expansion of the Medicaid health program for the poor.

NPR's Julie Rovner has our story.

JULIE ROVNER, BYLINE: It was no coincidence that the Obama administration released a detailed report on the how the across-the-board budget cuts could affect individual states, while the governors were all together in Washington. The president took the opportunity while meeting with the executives to do a little, well, lobbying.

PRESIDENT BARACK OBAMA: So while you are in town, I hope that you speak with your congressional delegation and remind them in no uncertain terms exactly what is at stake and exactly who is at risk.

ROVNER: But not all the governors are convinced that the cuts would be such a terrible thing. Among them is Nebraska Republican Dave Heineman.

GOVERNOR DAVE HEINEMAN: It's hard for me to believe that America is going to be devastated by the federal government cutting its budget two or three percent.

ROVNER: And it wasn't just the federal budget that occupied the governors during their closed door sessions. A major topic of conversation was Medicaid, specifically whether or not to go along next year with the expansion of Medicaid under the Affordable Care Act. Now, Medicaid is always a major topic of discussion for governors, says Oregon Democrat John Kitzhaber, a physician and longtime healthcare innovator.

GOVERNOR JOHN KITZHABER: The one consistent thing, though, is Medicaid is a real central issue on the minds of just about every governor. It's, in most states, growing faster than state revenue. They know it's not sustainable. They're very concerned about that.

ROVNER: But Medicaid is a more immediate issue than ever after the Supreme Court made that expansion optional. Until recently, most Republicans were still just saying no to the expansion, which would start next January. But this weekend, many seemed to be taking a somewhat different tack. Idaho Republican Butch Otter said calling it a shift would be wrong. He said it's more a matter of playing the hand he's been dealt.

GOVERNOR BUTCH OTTER: So we tried in court. We tried at the polls. Then in the polls for a new president. We tried for a new Senate. We lost on all those fronts, so now it's time for us to recognize that one of the most important tenets of a Republican form of government is the rule of law.

ROVNER: Idaho hasn't actually said yet if it will expand its Medicaid program. It's still in negotiations with the Department of Health and Human Services. That was something else going on behind the scenes at the governors' meeting. HHS Secretary Kathleen Sebelius was meeting individually with governors to see what it would take to get them to take the money.

OTTER: They've got a lot of coffee and a lot of water upstairs. I think they're meeting with almost every governor.

ROVNER: Under the law, the federal government has promised to pay 100 percent of the added Medicaid costs for the first three years and at least 90 percent after that. But one thing that seems to be holding a lot of governors back from committing to the Medicaid expansion is the question of whether that money will really be there.

GOVERNOR TERRY BRANSTAD: I think the big problem we've got is Medicaid is one of these out of control entitlement programs.

ROVNER: Terry Branstad is Iowa's Republican governor. He's worried that with the current state of the federal budget, Medicaid will inevitably end up on the chopping block and the promised funding will go away.

BRANSTAD: The federal government is going to have to deal with the situation and what they've done in the past is they just dump the cost on the states. We don't want to tie ourselves to a sinking ship.

ROVNER: So far only seven of the nation's 30 Republican governors have said they'll go ahead and expand Medicaid starting next year, but Oregon Democrat Kitzhaber says the most recent, Florida's Rick Scott, could change many more minds.

KITZHABER: He was also a very prominent opponent of doing what he's now decided to do and I think that gives other people permission.

ROVNER: Even the Republicans who remain opposed to expanding Medicaid in their states are now saying every governor has to do what's right for his or her individual state. That's a marked change from last year. Julie Rover, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

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