Republican Governors Release Medicaid Overhaul Proposal

The Republican Governors Association issued 31 recommendations for overhaul of the Medicaid program yesterday in a report called A New Medicaid: A Flexible, Innovative and Accountable Future."

The bottom line for the 31 Republican governors who make up the RGA is that Washington D.C. should step aside and let states design and run their own Medicaid programs with a lump payment every year from the federal government, and then hold states accountable for the results.

Gov. Haley Barbour of Mississippi, chair of the RGA Health Care Task Force, contends that states can best design their programs to provide for care to children, the poor and disabled without federal rules and the waivers required to get around them. He told the Associated Press, "We should not have to come to Washington on bended knee and kowtow for waivers to do these kinds of things."

The report calls for the repeal of the federal health care reform law, eliminating the maintenance of effort requirements on eligibility, and federal assumption of the uncompensated care costs of treating illegal aliens.

The Republican governors will travel back to Washington to present to the deficit supercommittee in October. “We began this work before there was a supercommittee,” Barbour said, according to The Hill. “But I think they will find it helpful … Many of these solutions will save money but also improve the quality of care, and that ought to be — and I expect is — exactly what the Congress is and should be looking for.”

The 31 policy solutions adhere to the following seven principles RGA already set out in a June letter to Congress:   

  • States are best able to make decisions about the design of their health care systems based on their respective needs, culture and the values of each state.
  • States should have the opportunity to innovate by using flexible, accountable financing mechanisms that are transparent and hold states accountable for efficiency and quality health care. Such mechanisms may include a block grant, a capped allotment outside of a waiver, or other accountable and transparent financing approaches.
  • Medicaid should be focused on quality, value-based purchasing and patient-centered programs that work in concert to improve the health of states’ citizens and drive value over volume, quality over quantity, and, at the same time, contain costs.
  • States must be able to streamline and simplify the eligibility process to ensure coverage for those most in need, and states must be able to enforce reasonable cost sharing for those able to pay.
  • States can provide Medicaid recipients a choice in their health care coverage plans, just as many have in the private market, if they are able to leverage the existing insurance marketplace.
  • Territories must be ensured full integration into the federal health care system so they can provide health care coverage to those in need with the flexibility afforded to the states.
  • States must have greater flexibility in eligibility, financing and service delivery in order to provide long-term services and support that keep pace with the people Medicaid serves. New federal requirements threaten to stifle state innovation and investment. In addition, since dual eligibles (individuals who are eligible for both Medicare and Medicaid) now constitute 39 percent of Medicaid spending, Medicare policies that shift costs to the states must be reversed, and the innovative power of states should be rewarded by a shared-savings program that allows full flexibility to target and deliver services that are cost effective for both state and federal taxpayers.

Read more about the report recommendations in Bloomberg News and The Wall St. Journal.