Saturday, December 26, 2009

The Great Compromise

It has been called the "Omaha Stakes" and the "Cornhusker Kickback," but was a Medicaid provision added to the Senate health care bill a simple payoff to Nebraska to secure Sen. Ben Nelson's pivotal vote?

I don’t care what it was, it should be illegal.

At issue here is a tiny clause tucked into a 383-page Manager's Amendment to the Senate health care reform bill. The wording of the paragraph is steeped in legal-ese, but it relates to money that states will have to pick up with regard to Medicaid. The Senate bill would expand Medicaid to people below 133 percent of the poverty level. And up until 2017, the federal government will pick up the tab for the added cost that will place on state governments. After that, states will have to start sharing the cost.

The provision added in the amendment will exempt Nebraska from that sunset, however, meaning that the federal government would forevermore pick up all of the expense of expanded eligibility to Medicaid in that state.

How can you make a provision for states to pick up costs and then exempt one state? I could see it if there were some criterion that states should meet to be exempted, but just to exempt one in a special deal?

South Carolina's attorney general, Henry McMaster, said he and his counterparts in Michigan and Washington were investigating whether the special provisions for Nebraska are unconstitutional.

Unconstitutional or not, it’s unethical.

Oh yeah, we don’t do ethical any more. We just do business.

And Nebraska's dealmaking Sen. Nelson claims it was done with other states in mind – to follow his example. Whether or not he had anyone else in mind with the deal, no doubt other states will be clamoring to have the provision changed for them.

If this thing ever gets passed, it will be tied up in court before it leaves the ground.

....but hey, do what you will anyway.

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