GOP govs name price on health law expansion

Two dozen Republican governors fought all the way to the Supreme Court to win the right to reject President Barack Obama?s expansion of Medicaid under?the health care law.?

However,?just a few weeks after the Supreme Court sided with them, some of these governors are leaving themselves an opening to expand Medicaid anyway ? but on their own terms.

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Five Republican governors said Friday they would consider expanding the program if the feds gave them Medicaid dollars in block grants, which has been a goal of Republicans since the 1990s.

That was when the states had their strongest leverage, with the help of a Republican Congress, to demand freedom from federal rules to reshape the social safety net the way they wanted it. They pushed a welfare reform bill that President Bill Clinton signed into law, and almost had the same success with Medicaid block grants. That idea was too much for Clinton, and he vetoed the bill that passed Congress.

And the idea mostly dropped away after that. It stayed on the Republican radar, but it didn?t get far enough to become part of a serious national conversation.

But now, the GOP governors have a friendly audience in the Republican House for that kind of flexible, no-strings-attached approach to Medicaid. And they think that, thanks to the Supreme Court ruling on the Medicaid part of the health law, they now have more power to demand it from the Obama administration.

At the National Governors Association meeting in Williamsburg, Va., on?Friday, Virginia Gov. Bob McDonnell, Nebraska Gov. Dave Heineman, Utah Gov. Gary Herbert, Tennessee Gov. Bill Haslam, and Wyoming Gov. Matt Mead all said their opposition to expanding Medicaid wasn?t absolute. If the Obama administration would throw in more flexibility to run their Medicaid programs their way, they said, they might be more willing to talk about expanding their programs.

Here?s how Herbert put it: ?They ought to be giving all states more flexibility, block grant the money and let us find our own unique ways with our own unique populations and demographics to find the best way to provide health care. ? The key word is flexibility.?

McDonnell stopped short of refusing Medicaid expansion outright, suggesting only that he?d oppose growing the program ?without reforms.?

Mead said that ?before we make a decision, we?ve got to do a full cost-benefit analysis to see how it will impact our citizens? ? but added that block granting Medicaid would make the expansion ?more palatable.?

And here?s how Haslam named his terms: ?Obviously, as a Republican, I?m with those folks who say, if you can block grant us Medicaid, we?d look at it differently.?

Not all of the governors said the goal had to be block grants, which implies throwing out pretty much the whole book of required benefits and eligibility standards. Some of the governors just want more freedom to make other Medicaid changes that have been high on their lists ? like charging co-payments to low-income patients for the first time.

?I wish the federal government would allow all states to determine the eligibility and benefits ? I?d like to see co-pays, for example, exist in our Medicaid system so you?ve got a little skin in the game,? Heineman said.

Source: http://www.politico.com/news/stories/0712/78499.html

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