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"Acts of God" and Medicaid Block Grants Do Not Mix

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As our nation watches Hurricane Isaac beat down upon the Gulf Coast and we pray for the safety of families being evacuated and seeking refuge from the storm at shelters across the State of Louisiana, Governor Bobby Jindal was quickly and wisely seeking federal emergency assistance from President Barack Obama. In his letter to the president, Governor Jindal requested "a cost-sharing adjustment to eliminate the State's non-federal share of the costs for this event." In other words, Governor Jindal is asking for the federal government to pay 100 percent of the emergency costs related to Hurricane Isaac.

And, as Governor Jindal concludes,

"...a core responsibility of the federal government is to protect the lives and property of its citizens when threatened. This disaster declaration will help ensure that we best protect life and property in our state."

Fortunately, when it comes to the medical needs for people in crisis, Medicaid is immediately responsive to these needs without the need for a plea or request from states. In fact, as businesses and people are harmed and displaced by disasters, such as hurricanes, tornadoes, economic recessions and tragedies like 9/11, and people lose their health coverage, Medicaid is responsive and provides immediate support.

Surprisingly, Governor Jindal, who is seeking 100 percent federal support from the federal government from the Federal Emergency Management Agency (FEMA) and will be undoubtedly grateful for increased federal Medicaid support in response to Hurricane Isaac, is supporting the idea of a Medicaid block grant. It is surprising because, under a block grant such as that proposed by House Budget Committee Chairman and Vice President Candidate Paul Ryan, Louisiana would be responsible for 100 percent of any increased costs associated with any hurricane or disaster.

Texas Governor Rick Perry, who is also supporting a Medicaid block grant, should know better as he has been governor when Hurricanes Katrina and Rita rocked the State in 2005. Fortunately, for Texas, the federal government stepped in to provide nearly $1 billion in aid to the State of Texas in response to these two hurricanes, including over $500 million in federal Medicaid support. However, under a Medicaid block grant, federal aid would be unresponsive or zero.

Governors, like fish that see the worm, need to open their eyes wider and see the hook. They may be enticed by some vague promise of flexibility, but they need to recognize the harsh reality that a block grant puts into place an arbitrary cap that is merely a tool for the federal government to walk away from its commitment to help our nation's most vulnerable children, people with disabilities, and senior citizens with medical assistance in times of crisis.

Fortunately, other political leaders from states in the Gulf Region can point the way, as they have long understood the enormous problems associated with Medicaid block grants. For example, when House Speaker Newt Gingrich proposed block granting the Medicaid program in 1995 (17 years ago), Florida Senator Bob Graham (my former boss) cited Hurricane Andrew, which devastated his state in 1992, as one of the many reasons the idea of Medicaid block grants should be rejected.

As he said on the Senate floor:

"What do the states relinquish in exchange for the marginal new flexibility that they will allegedly receive? The federal partnership to assist them, if they experience caseload growth will be surrendered."

Senator Graham added:

...when Hurricane Andrew hit South Florida, our Medicaid caseload shot up by 12,000 people. Not only had their homes been blown away, their jobs had been blown away. Therefore, people who had been employed and self-supporting needed the assistance of Medicaid during that time of crisis.

Under block grants, a State that is knocked down to its knees by a flood, earthquake, hurricane, would not find a helping hand from the federal government at the time it needed to get back on its feet. No, Mr. President, acts of God and block grants do not mix.