The Medicaid directors of all 50 states and the District of Columbia came together Thursday with a clear, unanimous message on Sen. Bill Cassidy’s health repeal legislation: it’s bad policy being pushed through an irresponsible process. The Hill’s Jessie Hellmann has more:  

“Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history,” the (National Association of Medicaid Director)’s board of directors wrote in a statement Thursday. … The directors also hit Senate Republicans for not having a full Congressional Budget Office (CBO) score before a possible vote on the bill, “which should be the bare minimum required for beginning consideration. … With only a few legislative days left for the entire process to conclude, there clearly is not sufficient time for policymakers, Governors, Medicaid Directors, or other critical stakeholders to engage in the thoughtful deliberation necessary to ensure successful long-term reform.”

Cassidy’s plan is being sold using misleading numbers as Vox’s Sarah Kliff reports. In fact, President Donald Trump’s administration studied the bill and found cuts similar to those projected by other non-partisan health analysts. It found that Louisiana would face a $2.4 billion cut in federal health care support in 2026, even without counting the cuts to traditional Medicaid included in the bill and factored into other analyses. Only 24 percent of Americans approve of Cassidy’s plan. The proposal would put significant strain on state budgets. The Center on Budget and Policy Priorities’ Michael Leachman:

States can’t afford cuts of this size. Cassidy-Graham’s Medicaid funding cuts equal 16 percent of projected state budgets in 2027. That’s more than what states provide for higher education. States that expanded Medicaid would face especially harsh cuts, and all states’ budgets would be squeezed by shrinking federal funding.

Louisiana speaks out against Cassidy bill

Louisianans are speaking out about the harmful consequences of Sen. Bill Cassidy’s legislation. Dr. Gerardo Negron wrote to the Shreveport Times.

The bill’s cuts to Medicaid seem particularly cruel, as they would not only impact people who have benefited from Medicaid expansion, but also children, people with living with disabilities and tens of thousands of elderly requiring nursing home care in Louisiana. It was my hope that Senator Cassidy would have written a bill that passed what he called the “Jimmy Kimmel test” — providing insurance to more Americans, lowering health care costs and protecting people with preexisting health conditions. Instead he did the opposite. I urge Senator Cassidy to abandon this misguided plan and focus on bipartisan solutions that strengthen — rather than weaken — our health care system.

Nola.com/The Times Picayune’s editorial board is opposed:

The shifting of costs from the federal government to Louisiana would leave the state with only bad choices: raise taxes significantly, slash health coverage, cut other state services to pay for health care — or all of the above, the Louisiana Budget Project has said. Louisiana has struggled to balance its budget for most of the past decade, and health care and higher education have absorbed deep cuts. If Congress pushes billions more in costs to states, many Louisiana residents would suffer.

Threat to home and community-based services

Funding for home and community-based health services, which allow Louisianans to receive health care at home instead of institutions, would be at risk under the Cassidy-Graham bill. The bill calls for a Medicaid per-capita cap, which would limits dollars available to those relying on the traditional Medicaid program, such as seniors, people with disabilities and low-income families with children. The Center on Budget and Policy Priorities’ Judith Solomon and Jessica Schubel explain why significant cuts to these programs would be likely could under Cassidy-Graham:

Capping and cutting federal funding would force many states to make excruciating decisions on whom they cover, the benefits they provide, and how much they pay providers, likely jeopardizing coverage and care for vulnerable populations that Medicaid covers. Seniors, as well as children and adults with disabilities, who rely on Medicaid-funded services to avoid having to live in a nursing home or other institution — and those who will need such services in the future — would be among those hit hardest. The cuts in Cassidy-Graham would likely prompt many states to roll back their progress in expanding access to care in the community and prevent them from making more progress in the future.

Spending the surplus
After learning the state finished the 2017 fiscal year with an estimated $140 million budget surplus – a rare treat after repeated midyear shortfalls – policymakers are offering ideas on how it should be used. House Speaker Taylor Barras proposed moving the full amount into the state’s Rainy Day Fund, while Senate President John Alario was noncommittal. Everyone seems to agree that the surplus is a good sign for our economy, though it won’t help offset the $1.5 billion fiscal cliff. Melinda Deslatte of the Associated Press has the story:

(Gov. John Bel) Edwards spokesman Richard Carbo said the Democratic governor hasn’t spoken to Barras about the rainy day fund repayment proposal but is “open to exploring” the idea. The legislative leaders and the Edwards administration have been tempered in their excitement about the surplus, as they stare down another massive budget hole. But officials say they hope the surplus is a sign that Louisiana’s economy is on the uptick. “It shows that we are heading in the right direction,” Edwards said on his monthly radio show.

Number of the Day

44,772 – Number of Louisianans participating in Medicaid-funded home or community based services, which are put at risk under the Cassidy-Graham legislation. (Source: Center on Budget and Policy Priorities)