Congress Versus the States: The Latest Chapter in the Medicaid Saga
Dennis Smith /
Eleven months ago, the Medicaid and CHIP Payment and Access Commission (MACPAC) was created by Congress. The Commission is supposed to review the policies, including payment policies, that affect the access of children to the services provided through Medicaid and the state Children’s Health Insurance Program. Two weeks ago, the Government Accountability Office (GAO) announced the appointment of the 17 MACPAC members. The Commission’s first report to Congress making recommendations is due in 36 business days. The appointees themselves are first rate, no one would dispute the credentials of the members individually or collectively. But they have been asked to toil in futility.
If Speaker Pelosi, Majority Leader Reid, and President Obama stick to their timetable for health care legislation, the MACPAC report will occur after the largest Medicaid expansion in history has taken place. Congress apparently is in too big of a hurry to hear from the panel of experts it assembled.
Congress already knows that individuals on Medicaid, including children, face serious access problems that are going to get worse. States have been cutting provider reimbursement for two years and will continue to do so because state budgets are in the tank. Yet Congress is intent on adding another 15-20 million people to that overburdened program.
Congress has set MACPAC up for conflict with the states without any substantive justification. Every state already has its own provider advisory committee to which physicians, pharmacists, hospitals and health plans can plea their case on reimbursement issues. Ultimately, payment issues are determined by the elected men and women who serve in state capitols. They must make decisions based not only on Medicaid, but also in the budgetary context of demands from education, child welfare systems, transportation and all the other priorities. Giving people authority without responsibility violates basic rules of sound public management.
MACPAC satisfied someone’s political itch at the time it was created. Since Congress is intent on ignoring the panel anyway, it should be disbanded before tax dollars are wasted pursuing a futile effort.