All this time, the national headlines about health care reform in Congress have prioritized the terms “CBO” and “pre-existing conditions.” Not nearly enough attention has been paid to “Medicaid.”
West Virginia senator Shelley Moore Capito, a Republican, mentioned the program Tuesday in the context of the Senate’s expected bill, Axios’s Caitlin Owens reports:
As the Washington Post’s Paige Winfield Cunningham has written, the “lower growth rate” refers to the difference between the overall Consumer Price Index for urban consumers (CPI-U), which is a general measure of inflation, and the indices for medical costs, which factor into the CPI-U. On an unadjusted basis, the CPI-U grew 1.9 percent from May 2016 to May 2017. The medical commodities and services indices grew 2.5 percent and 3.3 percent over the same span. The Senate legislation is expected to tie future Medicaid spending to the CPI-U, which has a “lower growth rate” than the medical care indices. (The House version of American Health Care Act links Medicaid to the medical care components of the CPI for the elderly and the disabled.)
Many prominent conservatives favor this idea. But key Republicans closer to the center on the Medicaid issue, including Ohio’s Rob Portman, a point man for negotiations, and Nevada’s Dean Heller, a vulnerable incumbent in 2018, do not. Portman favors growth in federal Medicaid spending at a rate of medical inflation plus two percentage points. Heller’s goal: “I just want to make sure that medical inflation as it increases over the next 10 years, the funding mechanism we have, isn’t below that,” he said earlier this month. But it would be under the Senate bill, if the reported details of the legislation are true.
Medicaid has presented other obstacles in the health care debate, including the phase-out of higher federal payments to those in Medicaid expansion states. Much of the internal GOP discussion there seems to concern how much time Washington should give individuals and states to adjust. The differences seem reconcilable. But the matter was a major hang-up for Portman and a few of his Republican colleagues during House consideration of the AHCA. “[T]he February 10th draft proposal from the House does not meet the test of stability for individuals currently enrolled in the program and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,” he wrote to McConnell in March; the letter was also signed by Capito, Alaska senator Lisa Murkowski, and Colorado’s Cory Gardner.
Centrist Republican Susan Collins and former presidential candidate Rand Paul, who represent the party’s ideological extremes in the Senate, are not expected to vote for the legislation. With only a 52-48 seat majority, that means Republicans’ margin for error is zero—and so Portman and Capito are about to get a lot of face-time.
