The Federal Bailout We Need: Medicaid

There’s an easy way to improve health care, improve the national economy, help out the states, and tell Mitch McConnell to stuff it. What could be bad?

David Brooks can’t seem to help himself, administering a gratuitous and inaccurate slap at The Shrill One today, but even Brooks acknowledges that we should extend unemployment benefits and help out state budgets, many of which are operating on fumes.  Brooks’ plan to aid states, though, is silly: he wants to have more programs like Race to the Top, which is an excellent initiative but far too tiny to yield any real state budgetary relief.

A better way to go about it would be greater Federal funds for Medicaid, which might also yield better health care governance and would have a greater budgetary impact.  And politically, the best thing about it is that it doesn’t need 60 votes.

Currently, Medicaid is a federal-state match, usually about 50-50.  Skyrocketing health care costs are a big reason for long-term, structural pressure on state governments: more than one out of every six state budget dollars are Medicaid expenditures, and depending upon how you count it goes up to one-fifth.  The states can’t just choose to stop spending a lot of this money, because if they did, they’d lose the federal match (although many states are hacking up as much Medicaid as they legally can).  If the federal government agreed to increase its matching share, this would significantly ease state budget woes, freeing up this money to preserve state expenditures and services in other areas.

Moreover, because these matching formulas are currently part of the Medicaid legislation, changing them could be done through the budget reconciliation process, avoiding the inevitable Republican filibuster.

I wouldn’t want complete federalization of Medicaid at this point, because that would require substantive changes that could run into reconciliation problems.  Besides, this would require yet another vote on abortion coverage (states whose Medicaid programs cover abortions — such as California’s — use only state funds in the accouting); let’s not go there again.

Note how the advantage here is both for the short run — helping out states currently facing budgetary disaster — and long-term.  States faced with Medicaid pressures can’t just print more money like the feds can, which means that Medicaid is always a budgetary headache.  If we want a more rational and more humane system, that can’t continue.

A good relatively recent summary of Medicaid and state budgets can be found here.

Author: Jonathan Zasloff

Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees. Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses. Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.

3 thoughts on “The Federal Bailout We Need: Medicaid”

  1. Did medicaid fixes get put into the reconciliation instructions in this year's budget? Were there even any reconciliation instructions at all in this year's budget resolution?

  2. "Brooks’ plan to aid states, though, is silly: he wants to have more programs like Race to the Top, which is an excellent initiative but far too tiny to yield any real state budgetary relief."

    I think you misunderstood what Brooks had in mind. He was (en passant)complimenting the Race to the Top program, and suggesting that a comparable program with presumably mega dollars be devised that would give money to those states which devised the best programs to get their fiscal houses in order. Vague idea but not necessarily silly.

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