The Republican Medicaid mambo

It is becoming increasingly impossible to keep up with the changing positions of Republican legislative leaders when it comes to Medicaid.

They clearly want to slash the program. The budget they approved this summer is plain evidence of that, cutting more than $700 million in state Medicaid spending over the next two years, an actual reduction of more than $2 billion since the federal government provides a two to one match for every state dollar spent.

Included in the cuts were savings that Republicans knew were impossible to achieve. Some of the Medicaid changes have not yet received the required approval from the federal government and the savings from a successful managed care Medicaid program are falling well short of the Republicans predictions.

The budget also orders officials with the Department of Health and Human Services to cut services and lower reimbursement rates to health care providers if the savings are not realized.

Two weeks ago lawmakers learned that the savings were indeed unrealistic. Officials with the Department of Health and Human Services told a legislative oversight committee that Medicaid is facing a shortfall of $139 million.

House Speaker Thom Tillis feigned ignorance after that meeting and said that if budget writers had known about the potential problems with the savings the budget would not have included them. But the same day Health and Human Services Secretary Lanier Cansler circulated copies of letters Governor Perdue sent legislative leaders in late May and early June detailing their concerns.

Tillis and his Republican colleagues knew and chose to ignore the warnings.

Their other seemingly unrelated defense was to blame the budget problems on one-time payments and refunds owed of bad decisions made by Democrats in previous years.

It is not clear how those payments and refunds are justification for counting on savings that you know will never materialize.

This Tuesday Medicaid was on the table again before another oversight committee and after Cansler explained the $139 million shortfall in detail, he asked lawmakers for guidance about how to handle it, pointing out the only two ways to find that kind of money were to slash provider rates by 18 percent or virtually eliminate all the optional services to the most vulnerable people in the state.

Rep. Nelson Dollar, the Republicans lead human services budget writer in the House, told Cansler he should “absolutely not” make either cut, even though the budget Dollar and his colleagues approved orders Cansler to slash rates or cut off services if the projected savings aren’t achieved.

Dollar said the Republican leadership would work with HHS officials to “find the money” to make up the difference. That’s certainly good news for people who need Medicaid services, but it doesn’t do much to clear up what Republicans really think of the program.

The budget they passed this summer says slash services and provider rates. Dollar, a key budget writer, says now that cutting services and providers payments would be a mistake.

The think tanks on the right that provide the Republican legislators with their talking points have long demanded deep Medicaid cuts and an end to the services the state has the option of providing, prosthetics, vision and hearing care, private-duty nurses and a host of other services that are hardly optional for the people who receive them.

Before they gained control of the House and Senate, many Republicans routinely made those ideological arguments against Medicaid, complaining about North Carolina’s “generous” program, as if providing an artificial arm to someone is over the top.

And that’s the philosophy written into the budget and behind the budget cuts, that Medicaid is a burden on the state finances, not a health care safety net for millions of seniors, children and people with disabilities that is operating with far lower administrative costs than private health care plans.

Maybe it’s not that complicated.

Republicans want to slash Medicaid and the services it provides regardless of who suffers because shrinking government and cutting taxes are more important to them.

They just don’t want the blame for what those cuts will do.