City Journal Summer 2014

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Summer 2014
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Nicole Gelinas and Paul Howard
A Medicaid Dilemma « Back to Story

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Texas just enacted a huge Medicaid waiver, and I believe that its Governor is a Republicans. Regardless, I would like to know what "innovation" or flexibility the author is referring to. The states have been under enormous budget pressure for at least five years and have every incentive to change their programs to be more cost efficient. So what can they now do differently to save money besides lower provider reimbursement further or push beneficiaries out of their programs?
Dean: The 'waivers' were meant as a way for the Democrats to reward favored interests, and punish those who do not toe the Democratic line. That is the one and only purpose of the provision - it's corruption plain and simple. But what else would you expect from these people?
A "grand bargain on Medicaid reform that promoted state innovation." It certainly sounds good in theory. But can anyone say what "innovation" exactly the States are now prevented from trying. With all of its different types of Waivers it seems, to the contrary, that the Federal government is bending over backwards to accommodate state innovation. The only "innovation" that the Federal government hasn't accommodated has been the forced dis-enrollment of persons deemed eligible for benefits under Title XIX. Is that what the States are looking for?