Throughout the first decade of the 21st century, conservatives in state capitals and in Congress supported a balanced approach of increasing health insurance coverage while granting states flexibility to design sustainable Medicaid programs for low-income residents that include personal responsibility.
States enjoyed broad flexibility to recreate Medicaid programs that reflected what was practicable and achievable.
The Affordable Care Act, popularly known as Obamacare, went in the opposite direction and Congress passed it on a strictly partisan basis. Obamacare took away states’ authority to regulate insurance markets.
Health care should not be a partisan issue, but current efforts by the Biden administration are pushing common sense aside. Make no mistake, the actions of President Joe Biden’s team are about further consolidation of power over Americans’ health care.
In 2020, Biden ran for president promising to improve access to health care for every American. Yet 10 months into his administration, Biden’s actions are unraveling the health care safety net for generations to come.
In recent months, the Biden-Harris administration has quietly moved to strip states’ ability to manage their Medicaid programs and transfer that power into the hands of unelected, unaccountable federal bureaucrats.
Under the Trump-Pence administration, the Centers for Medicare and Medicaid Services worked hand in hand with states that granted waivers from federal regulations so they could tailor innovative health care programs to meet the particular needs of their population.
These waivers are instrumental in providing states with the flexibility to develop pioneering new strategies for delivering higher quality health care to beneficiaries at a lower cost to taxpayers. Virtually every state has a waiver that allows it to become a “laboratory of democracy,” experimenting with inventive new approaches.
But as soon as Biden took office, federal bureaucrats unilaterally began rescinding Medicaid waivers already granted to states such as Texas, New Hampshire, Arkansas, Indiana, and Nebraska, to name a few.
In the case of Texas, the move jeopardizes millions of dollars that hospitals were counting on to care for their patients, even as the COVID-19 pandemic continues.
These strong-arm tactics represent an unprecedented move in the 40 years in which Medicaid waivers have been widely used. No other administration has canceled a standing waiver.
Moreover, the action ignored the Centers for Medicare and Medicaid Services’ own legal agreements with the states and provided no due process for states that had made significant investments in obtaining and implementing waiver programs. Most importantly, the revocations were timed to deny states their day before the U.S. Supreme Court.
At the same time, Biden erased major reforms authorized by the Trump-Pence administration that allowed states to require able-bodied, childless, adult Medicaid recipients to work, volunteer, or attend school in order to receive benefits valued at a median of almost $7,000 a year. Under our administration, nearly half of all states applied to add these commonsense community engagement requirements to their Medicaid programs.
These reforms brought Medicaid in line with other federal programs such as food stamps, which have had work requirements since the 1990s to prepare recipients to reenter the workforce, provide them the dignity of work, and offer a road to self-sufficiency.
Today, when employers are desperate for workers and too many jobs go unfilled, such a community engagement requirement could be a critical tool for governors to help employers fill job vacancies, address supply chain issues, and restore their state economies.
Medicaid already comprises the largest or second-largest line item in every state budget in America. Nearly 85 million Americans rely on the program for health coverage—an all-time high—and as baby boomers age, Medicaid’s costs are expected to double.
Health care in Alaska is not health care in New York. Without the flexibility to tailor state-specific programs and rein in ever-increasing costs, Medicaid’s growth threatens to undermine other critical programs such as education and public safety.
Unfortunately, the Biden administration’s message to every governor and beneficiary is clear: No state should embark on the difficult and complex process of submitting, negotiating, and implementing an innovative waiver program that could improve the quality of care for their most vulnerable citizens. Innovation and freedom are gone, one-size-fits-all federal mandates are here to stay.
The Biden administration has made clear that waivers may be rescinded at the whim of a federal bureaucrat with a stroke of the pen. In fact, administration officials have admitted that the real purpose of their actions has been to push reluctant state officials toward expanding Medicaid under Obamacare.
The magnitude of Medicaid is simply too massive and important to defer the judgment of governors and state legislatures to out-of-touch federal bureaucrats, no matter how well-meaning they may be. According to their constitutions, every state but one must have a balanced budget. Thankfully, states cannot print money or run budget deficits, unlike the federal government.
Fortunately, members of Congress are stepping up and reclaiming their constitutional responsibilities. Legislation filed this week by Republican lawmakers would allow states to restore Medicaid community engagement requirements for adults who aren’t disabled and don’t have dependent children.
Now Congress must clarify the bureaucracy’s authority to grant and rescind Medicaid waivers and fully restore the flexibility that states need to innovate with their Medicaid programs to increase value to beneficiaries and taxpayers alike.
By liberating the states from the heavy hand of the far off, disconnected bureaucracy in Washington, states will put Medicaid on a sustainable path and preserve it for the most vulnerable of this generation and those to come.
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