Governors to Congress: For Medicaid reform, repeal “ObamaCare”

In what could be an historic declaration of unity by a majority of the American states, 28 Republican governors – including Oklahoma’s Mary Fallin — have combined to argue for common principles in health care reform, including repeal of the most comprehensive health care law in U.S. history. 

The chief executives wrote in response to a May 23 letter from U.S. Sen. Orrin Hatch of Utah and U.S. Rep. Fred Upton of Michigan regarding challenges facing the state Medicaid programs. In a letter that drew nationwide attention on Monday, June 13, the governors said, “the first step for a successful Medicaid transformation is the full repeal of the Patient Protection and Affordable Care Act (PPACA).” 

Reflecting nuances in their approach, the governors wrote, “We agree that Medicaid should be reformed in a comprehensive and sustainable manner, not only to improve care for our nation’s vulnerable citizens, but also to address the inequities, inefficiencies, excess costs, fraud, waste and abuse that are unfortunately far too prevalent in the ‘all or nothing’ approach to Medicaid programs nationwide.” 

Concerning the federal legislation enacted in 2010, popularly dubbed “ObamaCare,” the governors contended, “The delivery of health care ultimately is personal and local. However, we have witnessed over the years as federal funding has expanded, so has federal control. Time and again, states have been caught in more intensive federal constraints that add little to the value of quality of services being delivered and thwart the creativity of the states.

“Indeed, states have proven themselves to be real innovators in health care delivery while the federal government has operated Medicaid in a very prescriptive manner. This, plus extensive federal mandates, has forced states to manage their programs through one cumbersome, time consuming waiver at a time. States should not have to see waivers to manage their unique programs. We must reassess and focus our efforts on reshaping how health care is delivered through innovation, creativity and responsibility – all demonstrated capabilities of states. We must bring the antiquated Medicaid program into the 21st century and secure the program’s long-term integrity. This will only be made more difficult under the PPACA.”

The governors contend, in their survey of the policy challenges still ahead, that critical flaws in Medicaid pre-existed the controversial 2010 health care law. 

They wrote in Monday’s letter, “Even prior to PPACA, Medicaid had become one of the most challenging components of the budget puzzle, consuming between 15 to 25 percent of most state spending. Moreover, a study published last year by the Deloitte Center for Health Solutions predicted, in a best case scenario, Medicaid’s proportion of state budgets by 2030 will consume up to 35 percent of spending in some states. At worst, it could nearly triple current spending levels. This consumption of state resources is crowding out other essential services such as education, public safety and even public health. This is not sustainable.”

Before listing key principles for reform, the governors wrote, “As Congress reviews the Medicaid program, it should provide states and territories a general healthcare framework where we can make necessary adjustments without constantly seeking permission from the federal government for changes that we already know work. 

“Governors must be able to provide quality healthcare for our most vulnerable citizens while containing costs. As the economy changes year to year, Governors almost must be able to make program adjustments in a timely manner in order to maintain a healthcare safety net.”

The governors listed seven principles for reform stressing the need for changes based on the “needs, culture and values” of individual states, flexibility including block grants, accountability and transparency in financing, patient-centered programs, streamlined and simplified eligibility, choice in coverage, and other reforms.
Those signing the letter included Governors Mary Fallin of Oklahoma, Rick Perry of Texas, Chris Christie of New Jersey, Mitch Daniels of Indiana, and Nikki Haley of South Carolina.