Congressmen, state health officials differ on Medicaid's future post-election

From left to right: Politico Executive Editor Joanne Kenen, Bill Cassidy, Rebekah Gee, Frank Pallone and Cindy Gillespie speak during Tuesday's event, "The Medicaid Agenda in 2017."  (Photo courtesy of American Speech Language Association)

State administrators and Congress members sparred Tuesday about the efficacy, politics and future of Medicaid, though all agreed that Medicaid is too important of a topic to ignore. 

Sen. Bill Cassidy (R-La.) and Rep. Frank Pallone (D-N.J.) disagreed about whether the Medicaid debate is simply an ideological rift, or a program that requires substantive reform--in the form of block grants or a per-capita cap on spending.

“Medicaid is such a fundamentally flawed program,” said Cassidy at the event hosted by PoliticoPro and sponsored by WellCare.

Noting the ideological bent to Cassidy’s approach to Medicaid, Pallone returned fire: Covering more than 70 million people, Medicaid is “one of the most successful programs we’ve ever had,” he said.

Louisiana Secretary of Health Rebekah Gee, M.D., added that in her state, Medicaid expansion under the Affordable Care Act has brought services to 300,000 residents who wouldn’t have gotten urgently needed medical services.

In the span of a few months, 1,000 women received mammograms who otherwise wouldn’t have had access to the service, Gee said. Expanding Medicaid in the state was “not about right versus left, it was about right versus wrong,” she added.

But despite the advances, Gee said there is still room for progress. While there are administrative inefficiencies in Medicaid, Gee conceded to Cassidy, the system will benefit correspondingly with the shift to value-based care. 

Regarding the future of Medicaid, particularly whether a Clinton presidency might sway more states to expand the program, Pallone said there isn’t much Hillary Clinton could do to change the politics of Medicaid expansion that President Barack Obama has not tried. But he did mention an important caveat: Clinton would have more political expertise entering office than Obama did.

House Democrats, he said, have a singular focus for Medicaid after the elections: Encouraging states that have not done so to expand eligibility, Pallone said.

To make expansion more viable for states, “flexibility is key,” said Cindy Gillespie, director of Arkansas’ Department of Human Services, who added, that it “matters that states have flexibility to run their own versions."

Arkansas Gov. Asa Hutchinson has been working with small businesses to increase enrollment in Arkansas Works, the state’s modified Medicaid expansion program, according to Gillespie. The next iteration of the program will feature small businesses enrolling Medicaid-eligible workers for quality health plans, where the employer will pay a share while the state foots the rest of the bill.