California Shortchanged On Healthcare Reform

The following editorial appeared in today’s San Franciso Chronicle.

Editorial: High cost of politics

Tuesday, December 22, 2009

At last, the U.S. Senate is within reach of health care reform. Over the weekend, Senate Majority Leader Harry Reid, D-Nev., nailed down the last few votes he needed to begin a round of voting on the plan. President Obama’s wish for a Christmas health reform package appears to be coming true.

Regrettably, the deals that Reid had to cut may leave Californians clutching a lump of coal. California was already receiving the lowest federal match for Medicaid dollars in the nation – a 50-50 split – a large part of the reason our state’s provider reimbursement rates are also among the lowest. Experts estimate that the low federal match rate costs California about $2.3 billion every year.

Under the new health care reform package, states with recalcitrant senators will receive especially large subsidies to expand their Medicaid programs, or, in the case of Nebraska – whose Democratic senator, Ben Nelson, was a key holdout – Uncle Sam will pick up the entire tab. In sum, California will be subsidizing health care reform in other states, and we won’t even be able to pay our own bills.

If there was ever a moment for California’s congressional delegation to step in and insist on equity for California, this is it.

The state budget won’t be getting any healthier for many years. If we’re to expand the Medicaid population – as is required by both the House and Senate health care bills – we’ll have no choice but to increase our provider reimbursement rates. (There aren’t enough providers who are willing to accept the Medicaid patients we have now, because the reimbursement rates are so low. It will be impossible for us to add more patients to the Medicaid rolls without adding more providers, too.) But we simply don’t have the money to do that, and it’s unfair that we should have to shoulder so much more of that burden than other states.

Most outrageously, it seems that California is being punished for not playing political extortion on the issue. Its top leaders in Washington – House Speaker Nancy Pelosi and Sens. Dianne Feinstein and Barbara Boxer – have been adamant about getting health care reform all along. Gov. Arnold Schwarzenegger has spoken up in support of reform. Because California’s votes – and voters – could be counted on to support health care reform, we’ve gotten far less than states with “moderates,” who are able to bully Congress into handing over more and more treats for their constituents.

Of the two bills, the House version is more generous to California. Feinstein and Boxer must push for its provisions in conference. And in the long run, all of California’s congressional leaders must push for an end to the inequities in federal funding that contribute to California’s budget shortfalls.

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