The disagreement between the Obama administration and Republican governors over how much say the federal government should have over Medicaid spending escalated today.
At a House Energy and Commerce Committee hearing, Gov. Haley Barbour (R-MS) made it clear that he wants control over how to spend Mississippi's Medicaid money.
"We shouldn't have to kowtow and kiss the ring" to make changes that will work for Mississippi residents, he said.
His solution: block grants, with no strings attached on how the money would be spent.
House Republicans have yet to officially propose block grants to help cash-strapped states cover the cost of Medicaid, the federal-state health insurance program for the poor. But just in case, Barbour made his case Tuesday for what he wants if Congress goes that route.
Barbour told the committee that he'd accept half of the annual national increase in Medicaid spending in return for a block grant.
Under the current system, the federal government matches each dollar states spend on the program, and those matching rates vary by state. Switching to a capped block grant would require states to cover the shortfall if expenditures exceeded the federal allotment.
After the hearing, Barbour predicted that other Republican governors would take that deal, too. Just how many? "More than you can count on one hand," he said.
Nearly 85% of Mississippi's Medicaid costs are currently paid for by the federal government, the highest rate in the country.
Barbour said that block grants would save the federal government billions and give states the freedom to make changes in the program that would decrease costs and improve coverage. For example, he wants to require Medicaid beneficiaries to take an annual physical exam to help detect and treat illness early. But the Medicaid program cannot require beneficiaries to do that, Barbour said, and so he must ask permission from the federal government before he can make the exam a requirement.
Committee Democrats said that block-granting Medicaid would leave states with inadequate funding, which would mean that fewer people have health coverage.
"The idea was discredited 30 years ago and it will be discredited again," said the panel's ranking member, Rep. Henry Waxman, D-Calif.
While he was at it, the possible-GOP-presidential-contender Barbour took a swipe at another possible contender — former Massachusetts Governor Mitt Romney. Romney's health care plan, enacted in 2006, helped guarantee almost every resident in the state is covered, but Barbour said what's ducky for Massachusetts isn't necessarily right for Mississippi. "We don't want that," he said. "We don't want extremely high mandatory standard benefits packages."
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