Washington Watch for Dec. 9, 2012

Cassidy pushes health plan

President Barack Obama has won re-election; with it his Affordable Care Act and the upcoming Medicaid expansion are the law of the land.

But that is not going to stop U.S. Rep. Bill Cassidy, R-Baton Rouge, from continuing to push for his “MAC Act” Medicaid plan. Whether he is tilting at windmills or not, Cassidy contends that because his plan would make health care spending more efficient it deserves a national debate to attract bipartisan support as a viable adjustment to Obamacare.

Students in a George Washington University graduate school-level class, “Federal Policymaking and Policy Advocacy,” wrote papers recently on Cassidy’s Medical Accountability and Care Act that he filed in June. Cassidy, who still works on a limited basis as a physician at the LSU Earl K. Long Medical Center in Baton Rouge, volunteered as a surprise lecturer this past week for the class the day after the papers were due.

Speaking to what he perceived as a generally more liberal audience than himself, Cassidy started out with some of his repeated lines from his days as a physician and part-time LSU professor. “I was famous for my lecture on diarrhea and hepatitis,” Cassidy said, but he stopped giving that one with the advent of YouTube.

But then he quickly gets into the crux of the debate and discussing care for the indigent in Louisiana. “My state is a very unhealthy state. I’ll just say it,” he said.

“Whenever Medicaid was expanded, I had longer lines for Medicaid (patients). Counterintuitive, isn’t it?” Cassidy said. “It’s the illusion of coverage without the power of access.”

Medicaid and Medicare are playing major parts in the nation’s debt crisis, Cassidy said. Medicaid spending has reached the point in many states that doctor providers are getting so little in payment for Medicaid patients that only about 40 percent of providers will see the indigent at all, he said.

Medicaid is the government health insurance program for the poor and is paid with federal and state dollars.

Medicaid funding now is based on a federal match to amounts individual states spend. Cassidy wants to give states more leeway for creativity for services provided, while limiting the amount of the federal match.

Cassidy says he is bothered by a system that he says rewards states like New York — with a lot of long-term disabled adults — that are “gaming the system” to milk as much Medicaid from the federal government as possible. “Medicaid is like a heroin addiction” for states, Cassidy said.

So that is why Cassidy prefers the MAC Act as a type of “per capita cap” system that he believes can draw more bipartisan support than the type of “block-grant” Medicaid system for states pushed by some Republicans and also entice more doctors to participate.

Cassidy’s bill would, over a 10-year phase-in period, adjust federal payments so states could only receive within 10 percent of the national average of what is received per capita.

The overall percentage of the federal share, known as the Federal Medicaid Assistance Percentage, or FMAP, would increase for 49 states because all states would pay the same as the state with the lowest percentage share.

Mississippi is currently paying the lowest percentage state share in matching fund at 24 percent, so every state would pay only a 24 percent share if that holds up. Doing so could benefit states from Louisiana to California, but hurt many in the northeast like New York.

The bill proposes distributing funds on a per-capita basis to states based on the number of Medicaid enrollees in four categories: the elderly, blind or disabled, children and adults. Louisiana has a lot more disabled patients while a state like Vermont has a lot more elderly ones.

The catch is that states like Louisiana would no longer be allowed to use provider taxes, intergovernmental transfers and so-called one-time dollars to cover their state shares.

Overall, the student audience seemed interested in and receptive to some of Cassidy’s ideas, but others seemed to see it as a more callous and economic approach.

“I’d feel bad about the disabled (in New York) who are going to lose insurance,” one student told Cassidy, who responded that it would motivate state officials to come together and become more efficient.

Jordan Blum is chief of The Advocate Washington bureau. His email address is jblum@theadvocate.com.