Midlands Voices: Proposed change to Medicaid would hurt our vulnerable citizens

The writer, of Omaha, is a Nebraska state senator who represents District 7. He is chairman of the NCSL Health Committee.

On April 15, I was honored to join a bipartisan delegation of state legislators from across the country representing the National Conference of State Legislatures (NCSL) at a meeting with President Barack Obama and Vice President Joe Biden in the White House. We had a substantive discussion about many items in the federal budget and how these issues would impact state governments and our citizens.

One key area in which we put aside our political differences to share a united concern was the pending proposal to radically transform the Medicaid program. Medicaid has a proud 40-year history as a federal-state partnership in which we share the responsibility to provide necessary health care for our senior citizens, children in poverty and those with disabilities.

Unfortunately, on the same day of this meeting with President Obama, the U.S. House of Representatives, with the support of all three of Nebraska’s congressional representatives, voted to transform Medicaid into a capped block grant system. If this proposal is adopted, each state would be provided with a fixed amount of funding to meet the health care needs of a population that are difficult to budget for and predict.

The block grant proposal would represent a massive cost shift, leaving the states to figure out how to compensate for the lost federal-state partnership. This was not an act of fiscal responsibility; it was simply a way to pass the problem to state governments while leaving vulnerable populations in the lurch.

The Medicaid program represents our obligation to those unable to care for themselves and to provide some basic level of health care and dignity to our fellow citizens. The majority of Nebraskans served through the Medicaid program are children. The greatest percentage of Nebraska Medicaid costs (64 percent) go to health care services for the aged, blind and disabled.

Medicaid helps us provide immunizations for children, nursing home care for senior citizens and community-based services for those with disabilities. With the transformation of Medicaid to a block grant program, states will be forced to either ration care for our most vulnerable or force state taxpayers to pick up the tab for all remaining costs.

Changing Medicaid to a block grant program would do nothing to address the fundamental causes of growing Medicaid costs. Increases are being driven by rising health care costs, an aging population and an economic downturn leaving more families in poverty. The health care needs of our seniors, our poor children and our disabled citizens would not just disappear if the federal government capped its financial participation in the program.

It is clear that we can and must reform the Medicaid program, in addition to the way health care is generally delivered in our country. We must advance policies that will demand more efficiency and accountability in Medicaid and crack down on fraud, waste and abuse. We should implement changes in the way health care is delivered by providing incentives for high-quality and coordinated care.

We can and will accomplish significant positive changes to our health care delivery system in the coming years, but we must not do so on the backs of vulnerable populations who rely on Medicaid to help them meet their most basic health needs.

As a member of the Appropriations Committee of the Nebraska Legislature, I believe deeply in the often-quoted adage that “a budget is a moral document.” A budget, ultimately, reflects the investments that we believe are necessary to create the kind of world in which we want to live and which we want our children to inherit.

We cannot separate the choices we make in budgeting today from the vision of the competitive and healthy communities, states and country we want to ensure for our future. Maintaining the strong federal-state Medicaid partnership would speak clearly to the value we place on protecting those least able to provide for themselves.

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