Democratic Governors To Congress: Don’t Shift Medicaid Costs to States

February 25, 2017

Democratic Governors To Congress: Don’t Shift Medicaid Costs to States

Dem. governors unanimously oppose block grants or per-capita caps 

Today, Democratic governors called on Congress to oppose health care plans that would shift costs to states and result in millions of constituents losing coverage.

Democratic governors are unanimously opposed to block grants or per capita caps, DGA Chair Dan Malloy (D-CT) and Vice Chair Jay Inslee (D-WA) wrote on Saturday in a letter to Congressional leaders. 

Democratic governors held a joint press conference Saturday during the National Governors Association meeting to voice their steadfast opposition to current Congressional proposals that shift Medicaid costs to states.  Meanwhile, Republican governors have been divided over how to proceed on health care plans.

“On behalf of the 125 million Americans we serve, Democratic governors strongly oppose any Congressional attempts to dramatically shift Medicaid costs to states via a block grant or per capita caps,” wrote Govs. Malloy and Inslee in a letter to House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. “Such proposals would harm our citizens, our state budgets and our health systems. Democratic governors speak with one voice: Do not rip health coverage from our citizens.”

Background:

  • Democratic governors are emerging as the nation’s leading voice against Medicaid block grant proposals because they would hinder access to healthcare and destroy state budgets.
  • The GOP block grant proposal would impose federal cuts that would shift cost to states and eliminate critical health services for elderly, disabled and low-income Americans.
  • The National Governors Association sent a letter urging House Republicans to preserve current Medicaid funding levels, writing “it is critical that Congress continue to maintain a meaningful federal role in this partnership and does not shift costs to states.”

LETTER:

February 25, 2017

The Honorable Paul Ryan

Speaker

U.S. House of Representatives

Washington, DC 20515

 

The Honorable Mitch McConnell

Majority Leader

U.S. Senate

Washington, DC 20510

Dear Speaker Ryan and Majority Leader McConnell:

This weekend, America’s governors are convening in Washington to share successes and challenges that our states face. For Democratic and Republican governors alike, one of the largest challenges is the economic uncertainty stemming from potential large-scale changes to the health care system.

As governors, it’s our job to solve problems and balance budgets. The plans proposed by Congressional Republicans would destroy state budgets.

On behalf of the 125 million Americans we serve, Democratic governors strongly oppose any Congressional attempts to dramatically shift Medicaid costs to states via a block grant or per capita cap. Such proposals would harm our citizens, our state budgets and our health systems. Democratic governors speak with one voice: Do not rip health coverage from our citizens.

The foundation of our current Medicaid system rests upon a 50-year partnership between federal and state governments. However, proposals to radically restructure Medicaid with block grants or per capita caps would flood states with new costs. Such plans would severely damage the ability of states to provide quality health care, inhibit innovative cost-control reforms, and devastate communities fighting opioid and substance abuse.

Block grants or per capita caps would throw state finances into disarray. And any claims that these proposals will enhance so-called “flexibility” for states to administer their Medicaid programs fall flat. There are avenues for flexibility within the current Medicaid program that facilitate important health care innovation and cost-saving programs. Those avenues should be maintained and strengthened. Block granting Medicaid would not provide flexibility; it would force states to cut residents from health care and foot the bill for drastic increases in uncompensated care. 

A massive cost shift to states would threaten public health, hinder efforts to combat substance abuse – particularly in rural communities, and negatively impact state finances across the country. The National Governors Association believes that “it is critical that Congress continue to maintain a meaningful federal role in this partnership and does not shift costs to states.”

Democratic governors are steadfast in their opposition to Medicaid block grants, per capita caps, or any funding shifts that place the burden squarely on states. Many of our fellow Democratic governors have voiced their concerns to congressional leaders. Excerpts from those letters are attached below.

We implore you to not risk the health care of millions of hard-working Americans.   

Sincerely,

                                                       

Governor Dan Malloy

Chair, DGA

State of Connecticut

Governor Jay Inslee

Chair-elect, DGA

State of Washington

CC:

The Honorable Kevin McCarthy, House Majority Leader

The Honorable Nancy Pelosi, House Democratic Leader 

The Honorable Charles Schumer, U.S. Senate Minority Leader

The Honorable Kevin Brady, Chairman, House Committee on Ways & Means

The Honorable Richard Neal, Ranking Member, House Committee on Ways & Means

The Honorable Orrin Hatch, Chairman, Senate Committee on Finance

The Honorable Ron Wyden, Ranking Member, Senate Committee on Finance

The Honorable Greg Walden, Chair, House Committee on Energy & Commerce

The Honorable Frank Pallone, Ranking Member, House Committee on Energy & Commerce

The Honorable Virginia Foxx, Chair, House Committee on Education & the Workforce

The Honorable Bobby Scott, Ranking Member, House Committee on Education & the Workforce

The Honorable Lamar Alexander, Chairman, Senate Committee on Health, Education, Labor & Pensions

The Honorable Patty Murray, Ranking Member, Senate Committee on Health, Education, Labor & Pensions

  

Democratic governors’ statements on cost shifts to states

Connecticut Gov. Dan Malloy, DGA Chair

“Proposals to reduce federal Medicaid spending by converting the program to a block grant or imposing per-capita caps necessarily erode the federal-state partnership and the access to health care for Medicaid beneficiaries. Reducing federal support will likely force states to limit services, drastically cutting coverage to thousands, and as a result, health care needs and costs will resurface in inappropriate and more expensive venues such as hospital emergency rooms, shelters and prisons.” (Letter to House Majority Leader McCarthy, 1.6.17)

Washington Gov. Jay Inslee, DGA Chair-elect

“If the discussion is Washington, DC is truly about improving the health system, we must continue to provide needed and appreciated coverage and services for the working families in our communities, in addition to the traditional Medicaid populations.” (Letter to Senate Finance Committee, 2.15.17)

New York Gov. Andrew Cuomo, DGA Policy Chair

“If Congress fundamentally alters Medicaid and the federal commitment to states by placing an arbitrary cap on federal expenditures, thereby shifting the significant risk of increased eligibility and rising medical costs to states and localities, it would endanger the significant gains in cost savings, access, and quality accomplished by New York.” (Letter to House Majority Leader McCarthy, 1.6.17)

California Gov. Jerry Brown

“I implore you to fight efforts to shift billions of dollars of costs to the states. That would be a very cynical way to prop up the federal budget – and devastating to millions of Americans.” (Letter to Senate Finance Committee, 2.15.17)

Colorado Gov. John Hickenlooper

“We are concerned that block grant and per capita cap proposals will make it difficult to maintain coverage and benefits for Coloradans over the long term. While Coloradans welcome conversations about granting states greater flexibility over our Medicaid program, greater flexibility cannot make up for a lack of funding. Cuts to Medicaid funding make our program less flexible by threatening our ability to ensure all Coloradans have access to quality health care.” (Letter to Senate Finance Committee, 2.15.17)

Delaware Gov. John Carney

“Economic downturns are accompanied by increasing demands for health care and social services. In the past, the federal government has been very responsive in financially assisting states to address these challenges. Reduced federal funding and proposed federal Medicaid reforms such as block grants would severely limit states’ ability to effectively serve impacted residents in such a crisis.” (Letter to Senate Finance Committee, 2.22.17)

Hawaii Gov. David Ige

“Per person caps are also problematic unless they can be risk adjusted based on disability and age factors, as well as catastrophic events.” (Letter to Senate Finance Committee, 2.15.17)

Louisiana Gov. John Bel Edwards

“[W]hile I am interested in pursuing discussions around state innovation and flexibility in the delivery of care, I am concerned that under a block grant or cap scenario, flexibility would really mean flexibility to cut critical services for our most vulnerable, including children, people with disabilities and seniors in need of long-term care.” (Letter to Senate Finance Committee, 2.23.17)

Minnesota Gov. Mark Dayton

“Block grants and per capita caps by definition eliminate the very features that have made Medicaid a success in Minnesota.” (Letter to Senate Finance Committee, 2.21.17)

Montana Gov. Steve Bullock

“Increased flexibility for states is a political imperative in places like Montana, but that flexibility should not be conflated with funding structures that will ultimately threaten the health of our state budget and reduce access to healthcare for tens of thousands of vulnerable Montanans.” (Letter to House Majority Leader McCarthy, 12.19.16)

North Carolina Gov. Roy Cooper

“I am concerned that proposals, which turn Medicaid into a block grant or a per capita cap may shift costs to states and undermine our ability to deliver vital care to our most vulnerable residents…Indeed, these changes are often offered in the name of flexibility for states, but in reality overturning the existing federal-state relationship could dramatically limit the options North Carolina has to address our most pressing health care needs.” (Letter to Senate Finance Committee, 2.17.17)

Oregon Gov. Kate Brown

“The current state-federal financing arrangement helps our state weather economic storms. Funding cuts and caps will inherently change the nature of the current Medicaid program, and limit our ability to fully respond to inevitable economic downturns. If Congress imposes caps or cuts to Oregon’s Medicaid program, Oregon may have to limit program eligibility, reduce the benefits that are covered by the program, and/or reallocate funding from other state programs when the next economic downturn occurs.” (Letter to Senate Finance Committee, 2.22.17) 

Pennsylvania Gov. Tom Wolf

“A move to end federal cost sharing relative to Medicaid expansion could quite literally devastate our state from a financial perspective or force us to make impossible decisions about which Pennsylvanians are entitled to quality health care.” (Letter to Senate Finance Committee, 2.16.17)

Rhode Island Gov. Gina Raimondo

“Avoid transferring costs to states. Any such shifts would be unaffordable and unworkable for the states. Likewise, we must avoid increasing the burden of uncompensated care for our hospitals.” (Letter to House Majority Leader McCarthy, 1.6.17)

Virginia Gov. Terry McAuliffe

“If they block-grant Medicaid, that is very problematic for the Commonwealth of Virginia.” (InsideNoVa, 2.17.17) 

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