Beware what you wish for….Governors and the block granting of Medicaid

In trying to duck their Medicaid responsibilities, Republican governors could be rushing into a long-term budget disaster for their states.

Fourteen years ago, Mickey Kaus and Peter Edelman held an engrossing bare-knuckled dialogue about the merits and pitfalls of welfare reform. For the youngsters, this 1996 bill abolished the 60-year-old Aid to Families with Dependent Children (AFDC), replacing it with the avowedly transitional Temporary Assistance to Needy Families (TANF), a block-granted program.

Looking back on that exchange, I suspect both antagonists have reason to feel themselves vindicated.

Edelman warned there–and in an embittered Atlantic article called “the worst thing Bill Clinton has done–that the recently-signed welfare reform would financially endanger the states because it removed their entitlement to federal funds for the needy people they were supporting. Edelman was wrong about that, because he was so right about something else: states’ eagerness and ability to punitively reduce the welfare rolls. In 1996, more than 12 million Americans received traditional welfare. Now only about 4.3 million do, despite population growth and the worst recession in several decades.

Republican Governors who support block-granting Medicaid may hope for a successful reprise of this experience. This won’t happen. In their haste to obtain immediate political victories and maybe some short-term fiscal relief, they are courting a long-term budget disaster for their states. At least that’s what I argue over in New Republic this morning.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

5 thoughts on “Beware what you wish for….Governors and the block granting of Medicaid”

  1. As a liberal, my fear with all of this budget balancing on the backs of the poor and needy is going to be felt by a people already marginalized and thus out of sight of public sympathy. 60 minutes did an excellent piece Sunday night on child homelessness – something I’m sure most people were unaware of. Yet for every such piece of journalism – watched as it is by a handful of souls, how many more storied are falling through the cracks. Here’s one for you: at our local city college, they are canceling the lowest 2 of 3 remedial English courses, a reduction in students that I’m guessing could number in the high 100’s.

    All of this, of course, sacrificed to the mythological low-tax, “pro-growth” model.

  2. I think you’re way too optimistic about the degree to which the governor and legislatures in question will play by the rules you think are there. All they have to do (and the software is there to do it) is cut back on payments for services that go primarily to poor nonvoters, and increase reimbursement to providers for the kinds of services that go primarily to well-educated regularly-voting types who are typically more compliant and more enjoyable to have in the office anyway. And when things go south, it will be time for more shock doctrine.

  3. One thing I’ve never understood is why public health isn’t considered part of our national defense (well, besides that it might mean spending money on people rather than weapons). Why is it more important to spend money on “homeland” defense than on viruses that can kill a lot more people? If drug-resistent TB gets you, you’re just as dead as from a bomb.

    I learned a lot from the Clinton administration (though I think he meant well). I don’t like flowery speeches anymore. I’m not as impressed by wonkery. Brains are not enough.

  4. NCG, here’s the glib version:

    Just the same way that icbms eliminated the idea of territory as a defensible quantity in national security (because an enemy has random rather than sequential access to your entire landmass) globalization as currently practiced has eliminated the idea of citizenry as a defensible quantity (because the people who count can prosper regardless of the health of the rest of the population).

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