Phaedrus has the skinny on the latest Publican scam to kill Medicaid, or at least force many of its recipients into private care. This is a new dodge, though, that claims states have been embezzling money from the thrifty Feds, money to which they’re not entitled. Ex-Wisconsin-Gov and now HHS-Sec Tommy Thompson, not noted for either his generosity or his accounting skill, is accusing the states of using accounting procedures to shift the burden of Medicaid payments to the Federal govt without, he says, paying “their fair share.”
In one example described by Tommy G. Thompson, the secretary of health and human services, county nursing homes borrowed $1.5 billion from a commercial bank. The money was transferred to a state account, then to the counties, which paid the loan. The state, which Secretary Thompson did not name, claimed it had spent the full amount on medical care and drew down more than $800 million in federal payments.
Actually, as a veteran local-govt-watcher and sometime inside man, this sounds to me like the kind of robbing-Peter-to-pay-Paul maneuver that state and local govts find themselves forced to in order to meet their obligations. By itself, there’s nothing particularly fishy about it. In order to stretch every dollar to its limit–and often to satisfy the requirements of the funders–public money is frequently shifted through various accounts as it slowly makes its way to the people who will use it. The Bush Admin has decided to call that “phantom money.” The states, quite rightly, disagree:
[T]he Bush administration says…states have paid their share with “phantom dollars,” instead of state or local tax revenues.State officials acknowledge their desire to make the most of federal Medicaid payments at a time when health costs are soaring. The National Conference of State Legislatures advises its members on “Medicaid maximization” strategies and says such techniques are legitimate and desperately needed to avoid cutting benefits for poor people
What Thompson and the BA have decided to attack as “gamesmanship” is the practice of borrowing money from banks or shifting it temporarily from one program to another in order to cover shortfalls that are usually the result of late Federal or State budgets, or promised money that has been withheld by the govt funders because if you can delay dispersing it, the money that’s supposed to go out instead stays in a bank and gathers a few months more’s worth of interest–an accounting trick of theirs. The Feds play that game with the States, the States play it with the counties, and the counties play it with the towns. It’s a long, drawn-out stall that nets each stage of govt its pound of flesh and forces each downstream stage into an ever more complicated dance to cover their obligations until that money eventually reaches them.
It sounds very much to me as if that’s all that’s going on here, but the BA wants to cut Medicaid and can’t because it’s a politically popular govt program, so it’s looking for an excuse, trumping up charges of “fiscal malfeasance.”
Melanie M. Bella, the Medicaid director in Indiana, said she had been negotiating with federal officials for nearly a year on a proposal to increase payments to doctors from the Indiana University School of Medicine who care for Medicaid patients at the county Wishard Memorial Hospital in Indianapolis.The county is willing to pay the state’s share of the extra cost. But the Bush administration says it wants to curb such “intergovernmental transfers” because they have been abused in the past to gain what the budget described as “inordinate amounts of federal Medicaid funds.”
“It would be a real hardship if we cannot use county tax money,” Ms. Bella said. “This is headed down a path that will increase the number of uninsured. With the proposed restrictions on our use of state and local revenue, states will have to cut services, reduce payments to health care providers or eliminate groups of recipients.”
“This is headed down a path that will increase the number of uninsured.” Now why would the Bushies want to do that?
In his new budget, President Bush said he could save $1.5 billion next year and $23.6 billion in the coming decade by restoring the “fiscal integrity” of Medicaid.
There you go. Bush wants to lower the deficit he created by cutting the taxes of his rich friends and contributors, and he wants to do it by forcing the old, the infirm, the poor, and the disabled to fend for themselves again, just like in the old days before FDR. He’s using this bogus “fiscal integrity” canard to excuse and cover up what he’s really after–the systematic destruction of a program the rich hate and have hated for 60 years, whatever name it went under. Phaedrus nails them:
If you’re a hard-hearted bastard who wants to fuck over the poor, the elderly or the disabled, fine. You gotta right. But say so. Say it out loud, ya sonuvabitch! Quit hidin’ behind “principle.”