Over the last couple of weeks two letters have arrived on President Obama’s desk; one from a group of governors and one from a group of senators. They exhibit significantly different perspectives on the future of Medicaid.
The letter from 29 governors was written “regarding the challenges states face with our Medicaid programs”. They advocated for a full repeal of the PPACA and for 7 guiding principles that revolve around a simple idea: states can serve their citizens better. They state, “Indeed , states have proven themselves to be real innovators in health care delivery while the federal government has operated Medicaid in a very prescriptive manner.” One statement shows a unique belief these governors hold, “The delivery of health care ultimately is personal and local.” They did not advocate for a specific reform package, but instead asked for more flexibility for their state and their citizens. The senators’ letter was different.
The letter that came from a group senators asked the President to resist calls for block granting Medicaid. They claim that fixing or capping federal funding prevents Medicaid from automatically adjusting to changes. According to these senators any less funding or more flexibility will inevitably lead to destruction of benefits for individuals. Accordingly, the Federal government, not the states, must retain control of Medicaid.
These two perspectives are telling. On one hand these senators have spent years in Washington, DC legislating on behalf of constituents hundreds of miles away. They believe in the ability and capacity of the federal government because that is what they see and that is what they know. On the other hand these governors are living in their states and communities on a daily basis, in the trenches some would say. They see the ability and capacity of their citizens. These politicians want more control, but not for the sake of control. The senators want control because they have faith in the federal government, but the governors want control because they have faith in the people.
Despite the abject failure of Medicaid in a fiscal and quality of care sense, these senators continue to press on in pursuit of maintaining the status quo. But make no mistake, the future of quality care for needy individuals rests in the states and their citizens, and these governors are at the forefront of reform.
-Spencer Harris