Health Reform and the States

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Although the battle over passing health reform is being waged here in Washington, the front lines for implementing whatever passes will be the states. In the new issue of the print magazine, Kate Pickert and I look at what that means.

The latest evidence of the Governors’ growing concern about what lies ahead came in the State of the State speech yesterday of California Governor Arnold Schwarzenegger, who had been one of President Obama’s few Republican allies in the health effort:

We no longer can ignore what is owed to us or what we are forced to spend on federal mandates. We are currently owed billions of dollars by the federal government for various different programs. We need to work with the feds so that we can fix the flawed formula that demands that the states spend money that we do not have.

And now Congress is about to pile billions more onto California with the new health care bill. Now, as you know, while I enthusiastically supported health care reform, it is not reform to push more costs onto states that are already struggling while other states are getting sweetheart deals. Health care reform, which started as noble and needed legislation, has become a trough of bribes, deals and loopholes. Yet you’ve heard of the bridge to nowhere. Well, this is health care to nowhere.

California’s congressional delegation should either vote against this bill that is a disaster for California or get in there and fight for the same sweetheart deal that Senator Nelson of Nebraska got for the Cornhusker State. (Applause) Because that senator got for the Cornhusker State the corn and we got the husk. (Laughter)

That deal that Nelson got, of course, is one in which the federal government would pick up the tab–permanently–for the cost of medicaid expansion in his state. At this point, 13 state attorneys general have challenged the constitutionality of that special arrangement for Nebraska.

In recent weeks and days, several Democratic Governors–including New York’s David Paterson and Tennessee’s Phil Bredesen–have also expressed concern about what the health bill would mean for their state budgets.

One thing that has infuriated some is the fact that the bill seems to penalize states that have actually been doing a better job of covering their low-income citizens. Under its formulas, they would get less help from the federal government than states that have been stingy with their medicaid programs, and would suffer some cuts in other areas. In New York City, for instance, Mayor Michael Bloomberg has warned that the bill would cost the city’s Health and Hospital Corp. at least $500 million and force it to close 100 clinics. As Bloomberg put it: “We provide a level of care that is unparalleled in this country, and this bill basically penalizes us,” (A political irony here, too, is that this bill sets up what could be a massive transfer of wealth from the Blue States to Red States.)

This tension is worth keeping an eye on as negotiations go forward on the final shape of the bill.