State lawmakers vow to fight variations in health overhaul's costs for Medicaid expansions

Newspapers report on the controversy about variations in individual state costs for a Medicaid expansion in health care overhaul legislation.

"Gov. Phil Bredesen [D-Tenn.] said today that he is 'very distraught and concerned' about the direction health care reform is moving at the federal level and 'moderately outraged' at the inconsistent treatment states could receive," the Nashville Business Journal reports. Bredesen "estimated a mandated expansion of Medicaid could cost the state as much as $1.2 billion over five years," at a time when the state's Department of Finance and Administration found that Tennessee needs "to make a combined $1.5 billion in budget cuts in the current fiscal year's state budget and next year's budget."

"In order to secure votes for the Senate version of the bill, the blow of Medicaid expansion was softened for some states. For example, Nebraska would never have to pay for Medicaid expansion and Louisiana would receive an extra $300 million in Medicaid funding. Bredesen said the deal-cutting is bad policy and that he expressed his displeasure to Tennessee's congressional delegation. While sympathetic, Bredesen said the delegation was not hopeful anything could be done. Bredesen was similarly pessimistic about negotiations being carried out by the National Governors Association" (Gee, 1/4).

The (Columbia, S.C.) State: "S.C. Attorney General Henry McMaster said Monday a plea from U.S. Sen. Ben Nelson to 'call off the dogs' won't deter him from fighting a provision in the Senate's health care bill that favors Nebraska. In fact, McMaster's initiative to prepare legal action against the provision gained more support Monday when Oklahoma's Drew Edmondson became the 14th attorney general -- and the first Democrat -- to sign on. … McMaster, a Republican running for governor, said his research has uncovered more potential constitutional flaws with the legislation, including another provision that gives Florida an advantage" (Wenger, 1/5).

Meanwhile, some middle-class families will still likely be unable to afford insurance under the proposed reforms, despite a Medicaid expansion and the creation of subsidies for many Americans to purchase insurance, Kaiser Health News reports. The dilemma "faces many of the millions of Americans who are intended beneficiaries of the overhaul: they make too little, and yet too much, to capitalize on the legislation's signature features. In an effort to reduce the ranks of the uninsured, Congress is proposing to expand Medicaid for the poorest Americans, and to provide subsidies to millions of others to help buy private coverage. But a sizeable number of those who would qualify for subsidies--especially people who would be right above the Medicaid cutoff--could still find health care unaffordable; premiums and out-of-pocket costs like deductibles and co-pays could add up to hundreds or thousands of dollars a year" (Schmitt, 1/5).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.