The Senate Saves the 10th Amendment The health-care bill would liberate states to bypass ObamaCare rules and better manage Medicaid. By Avik Roy
https://www.wsj.com/articles/the-senate-saves-the-10th-amendment-1498518832
For decades American conservatives have sought to restore meaning to the 10th Amendment, which recognizes the states’ right to manage their affairs free from Washington’s interference. Passing the Republican Senate’s health-care bill would represent historic progress toward that goal.
In nearly every state, Medicaid is either the largest or second-largest budget line, as well as the fastest-growing category. Every year state lawmakers, trying to carry Medicaid’s heavy burden, are forced to make difficult choices about what else to cut: education, roads, public safety.
Especially frustrating is that state officials have little control over how to manage their Medicaid programs. The 1965 Medicaid law contains dozens of limits on what states can do to avoid waste, fraud and abuse. In the half-century since, Washington has added to that burden with more laws and regulations.
Governors and state legislatures ask Washington every year for the right to receive their Medicaid funds in the form of a block grant, which would give them autonomy to manage the spending as they see fit. The Senate bill, for the first time, would allow that.
States that forgo the block grants would still receive additional flexibility through per capita allotments, an idea first proposed by President Clinton in 1995. The Senate bill would limit the growth of federal spending on each able-bodied enrollee to the rate of medical inflation, and on elderly and disabled enrollees to medical inflation plus 1%. After 2025, per-enrollee spending would be tied to overall inflation. The net effect would be to reduce overall federal spending on the pre-ObamaCare Medicaid program by up to 2% from projected levels over the next 10 years.
In exchange for putting Medicaid on a budget, states would gain substantial latitude to use funds more efficiently. Example: Thanks to ObamaCare, states are permitted to verify a recipient’s eligibility for Medicaid only once a year. As a result, scarce dollars continue going to people who become ineligible. Of the 10% (or more) of Medicaid spending that is improper, the majority goes to ineligible recipients, according to the Foundation for Government Accountability and the Centers for Medicare and Medicaid Services.
The Senate bill would liberate states from many other ObamaCare burdens. It would oblige the Secretary of Health and Human Services to grant all state waiver requests unless they increase federal spending, and to issue a final decision on waiver applications within six months of receiving them. Under current law, waivers are at the secretary’s discretion and there is no deadline.
The new waiver process would let states reduce premiums and health-care costs by bypassing a broad array of ObamaCare provisions, including benefit mandates and requirements that all individual policies be part of a single risk pool. Waivers would last eight years, with the option to renew. CONTINUE AT SITE
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