It’s a sad state of affairs that you have to bribe state governments to get them to give health insurance coverage to children, but that’s where we are in this new cruel version of America. So bribe the states we must, and we will.
The Obama administration plans to announce Monday that it will make $206 million in bonus Medicaid payments to 15 states — with more than a fourth of the total going to Alabama — for signing up children who are eligible for public health insurance but had previously failed to enroll.
The payments, which were established when Congress and President Obama reauthorized the Children’s Health Insurance Program in 2009, are aimed at one of the most persistent frustrations in government health care: the inability to enroll an estimated 4.7 million children who would be eligible for subsidized coverage if their families could be found and alerted. Two of every three uninsured children are thought to meet the income criteria for government insurance programs.
Kathleen Sebelius, the secretary of health and human services, has called the matter “a moral obligation” and has challenged health care providers, state and local governments and community groups to seek out eligible children.
One of the back-door ways in which state governments balanced their budgets in recent years is through avoiding with all their strength from actually delivering benefits to eligible constituents, particularly in health care. California recently made the Medicaid enrollment form more difficult to fill out in a bid to save money. Because state participation in health care is so burdensome, and because states can plausibly deny any effort to control enrollment, the feds have to work to force states to get coverage to beneficiaries. I’d consider it money well spent, if it wasn’t so confounding that state leaders are so cruel as to not do this for themselves.
What you’re seeing is a slow creep toward a federal takeover of programs like CHIP and Medicaid. If states simply won’t protect their citizens with these programs, the feds have an obligation to smooth outcomes regardless of location. State budgets would be much easier to balance if relieved of the burden of Medicaid and other programs of that nature. Obviously, a sustainable federal Medicaid program would require more tax collection. But there’s money for Medicaid expansion in the Affordable Care Act that will place almost all of the burden on the federal government, and it actually saves money over the long term.
Without more of a federal oversight role, conservative state governments are almost certain to shirk their responsibilities under the health care law, resulting in more uninsured than projected. It’s sad that these states will have to continue to get bribed by the federal government, while states that do a good job of enrolling children or the poor essentially get penalized.