Week In Review, Alliteration Version: Medicaid, Medicare And Missouri Ballot Initiative

Medicare, Medicaid and Missouri were the buzz words this week in health policy news.

Senate Democrats won a long-fought victory by passing a proposal to extend enhanced Medicaid payments for states as part of a broader state aid package. Kaiser Health News provided a recent history of the legislative effort, including the Senate’s previous failed attempts to pass a bill (Villegas, 8/5). 

When Democratic leaders delayed a scheduled Monday night vote because of an unfavorable Congressional Budget Office cost estimate, it appeared the proposal was again floundering. According to The Hill, the measure”wasn’t fully paid for” and “[i]t was unclear Monday whether the fiscal aid measure had the necessary 60 votes to move forward, as Republican leaders have criticized the bill as a tax increase and unnecessary spending” (Alarkon and Bolton, 8/2). Fortunes changed when Democrats pinpointed cuts and tax hikes adequate to cover the legislation’s costs – “a key Democratic move to counter the GOP charge that their spending would add to the deficit,” reported The Fiscal Times. “Without the additional aid, many states would be facing immediate budget crises this summer and fall. Some 30 states counted on Congress continuing aid to Medicaid in their budgets” (Pianin and Graham-Silverman, 8/5).

In addition, The Wall Street Journal noted that “Democrats dropped plans to cut $107 million in funds expected to go largely to Bath Iron Works, a General Dynamics Corp. facility that builds Navy ships in Maine” in an effort to attract the support of Maine’s two Republican senators (Bendavid, 8/5). Politico said a “sudden turnaround followed twin 61-38 Senate votes in which Maine Republican Sens. Susan Collins and Olympia Snowe joined in support” of the proposal (Rogers, 8/4). 

Speaker Nancy Pelosi announced Wednesday – via Twitter – that she would call House members back to Washington from their August recess to act on the funding measure. The Hill provided details: “The House will hold its vote on the package Tuesday. The decision by Pelosi seems to have caught lawmakers by surprise. A House leadership aide said that, while members were aware of the possibility that the Senate could act on the aid package and force their early return, ‘no one counts on the Senate” (Berman, Bolton and Pecquet, 8/4). And, on Thursday, the Senate gave the package its final nod by a 61-39 roll call vote, Politico reported (Rogers, 8/6).

(For complete news coverage, read KHN’s Morning Edition for August 3,  August 5 and August 6. KHN also offers summaries of news about the impact of this vote on specific states.)

The solvency of Medicare and Social Security also grabbed headlines when the programs’ trustees issued their annual fiscal report card. They concluded that changes put in place by the new health law will extend the Medicare program for a dozen more years, until 2029, The Washington Post reported. But, “the relatively bright picture of Medicare’s future triggered immediate debate over whether the forecast … is realistic. The trustees cautioned that the improved outlook for Medicare hinges on a sustained commitment by the government and the health-care industry to rein in medical costs” (Goldstein, 8/6).

The New York Times added that the report’s release came “at a time of growing political ferment over the future of [Medicare and Social Security]” and provoked a range of reactions (Pear and Calmes, 8/5). For instance, the Los Angeles Times wrote that “[s]enior administration officials and Democrats on Capitol Hill hailed [the report’s projection] as validation of what House Speaker Nancy Pelosi (D-San Francisco) called the ‘remarkable impact of health reform’ (Levey, 8/5).  According to USA Today, the GOP response was “not so fast.” Republicans noted “that the same savings are being used to help extend health insurance to 32 million more Americans. ‘If you steal over a half-trillion dollars from Medicare to fund another unsustainable entitlement, Medicare won’t be better off,’ said Sen. Orrin Hatch, R-Utah.” And Medicare’s chief actuary said “Congress still must find a way to avoid a proposed 30% cut in payments to doctors over the next three years. He added that most health care providers aren’t likely to improve their productivity as much as forecast by the law” (Wolf, 8/6).

(Read the report here. Kaiser Health News Morning Edition also details the news coverage on August 5 and August 6.)

The buzz might have been loudest on a Missouri referendum. Voters overwhelmingly approved a ballot initiative on Tuesday that directly challenges the federal health reform law’s individual mandate — not only previewing similar questions being posed on other state ballots in the weeks and months to come, but also raising health reform’s political stakes as the mid-term elections approach.    

The Kansas City Star explained Proposition C: “The measure is intended to invalidate in Missouri a key element of the federal health care law passed by Congress and signed by President Barack Obama in March. That law requires individuals to purchase health insurance beginning in 2014″ (Noble, 8/4). The New York Times described the referendum as “a first look at efforts by conservatives to gather and rally their forces over the issue. In the end, though, the referendum seemed not to capture the general population’s attention. Instead, Republican primary voters (who had the most competitive races on Tuesday) appeared to play a crucial role in the vote’s fate” (Davey, 8/3).

According to The Hill, health reform advocates “dismissed” the importance of the vote. White House press secretary Robert Gibbs “said Missouri’s vote … was ‘of no legal significance.’ Asked what it means that voters in Missouri would vote against the federal mandate, Gibbs said: ‘Nothing.'” (Youngman, 8/4). And, even as The Christian Science Monitor looked ahead to the upcoming ballot initiatives in other states, such as Arizona and Oklahoma, their coverage pointed to focus of opponents. “A greater threat to the health reform law comes in the form of lawsuits that challenge its constitutionality. Earlier this week, a federal judge in Virginia allowed one of these lawsuits to go forward, challenging the individual mandate. Another lawsuit, filed in a Florida court, argues that the law requires states to expand Medicaid rolls without covering the added costs. Another threat could come indirectly through the ballot box, if voters oust enough Democratic incumbents to shift the balance of power in Congress” (Trumbull, 8/4).

(For more detailed coverage, read KHN’s Morning Edition for August 4 and August 5.)