Bay State seeks fair shake in health bill

Mar 12, 2010 — The Boston Globe

By Susan Milligan

Mar. 12, 2010 (The Boston Globe delivered by Newstex) --

WASHINGTON - President Obama's demand to delete ``special deals'' in the health care package would eliminate $500 million in extra Medicaid cash for Massachusetts, but Bay State lawmakers say they are confident the state would recoup that and probably more once negotiations are complete.

Obama, facing an electorate angry over side deals in the massive package, has told congressional leaders to remove them to make the proposal more salable to the public. One of those deals is a Senate provision to reimburse Massachusetts and Vermont for having already expanded Medicaid coverage to a broader base of low-income people.

But Senator John F. Kerry, a key Obama ally in the health care talks, said the White House has given him personal assurances that Massachusetts will not suffer in the final package.

``I'm confident we will resolve this issue in a way that is fair to all states, and Massachusetts will come out stronger than we are now,'' Kerry said as he left a Democratic Senate caucus meeting on health care. One way, he said, would be to fix the Medicaid reimbursement formula so that all states are repaid up to a certain level, giving Massachusetts what it needs without appearing to single it out for special treatment.

``We will not be penalized for going above and beyond federal mandates, and believe me, we've sent the message loud and clear, and I'm confident it's been received and understood at the highest levels,'' Kerry said. ``The White House and congressional leadership have assured us that Massachusetts will get the money we deserve.''

Representative Edward J. Markey, Democrat of Malden, said Nancy Ann DeParle director of the White House Office of Health Reform, had specifically mentioned the so-called do-gooder states in a closed briefing yesterday with House members, indicating that Massachusetts and Vermont would be compensated in some way.

``We're in the game,'' said Markey, who is leading the House's Bay State delegation in fighting for the money. ``We obviously do not believe we should be harmed for going first'' in covering more people under Medicaid.

Denying Massachusetts the extra cash would be a slap to Bay State lawmakers who enjoy a close relationship with the White House. Governor Deval Patrick is a friend of the president's, and Kerry was critical in shepherding the health care bill in the Senate Finance Committee. Markey is a key House ally of the administration.

``Governor Patrick has worked closely with our partners in the Obama administration and our congressional delegation to ensure that the key components that have led to our success are protected and that recognition is given to the early investments that states like Massachusetts have made in helping cover the uninsured,'' said Juan Martinez, Patrick spokesman.

Democratic leaders are considering several strategies to pass comprehensive health care, including having the House pass the Senate-approved bill from late last year, despite objections on the side deals and other provisions. The Senate and House would then pass a companion bill that ameliorates those problems before the first measure takes effect.

Harry Reid, Democrat of Nevada and the Senate majority leader, told his GOP counterpart, Mitch McConnell of Kentucky, yesterday what had been assumed for weeks: that Democrats will use the budget reconciliation process to get final passage of the companion bill. Such bills require only a majority vote for passage.

The Medicaid issue is a key sticking point in the final negotiations of the companion bill, which Democrats are expected to reveal as soon as today. Lawmakers decided yesterday to adopt the Senate language on health insurance funding of abortion, which is less restrictive than the House-approved version. That decision could cost Democrats votes in the House but would appease lawmakers who back abortion rights and believe other parts of the bill are too conservative.

The Medicaid language is critical to Massachusetts, which offers the most coverage under the state-federal program. The state allows people earning up to three times the poverty level to get Medicaid; the federal government pays half the cost.

Other states have tighter eligibility limits for Medicaid but enjoy higher reimbursement rates from the federal government, a senior Kerry aide said. The average federal share is 57 percent of the cost.

The Senate bill would force all states to expand Medicaid and would help to pay the cost of the added coverage. But because Massachusetts and Vermont already cover an expanded pool of low-income people, they would not receive extra money for it unless a special provision were added. Massachusetts would get $500 million over three years to make up the difference.

Obama, however, wants to strip the legislation of anything that reeks of the back-door deals that have enraged the public and eroded support for the health care package. While what has been dubbed the ``Cornhusker Kickback'' to give more aid to Nebraska is the most notorious of these items - especially since Nebraska Democrat Ben Nelson was a pivotal vote - the money for Massachusetts and Vermont also falls into that category, the White House said. The news website Politico first reported the list of affected states.

``We're asking the Senate to take back any provisions which favor one state over the other,'' said Reid Cherlin, a White House spokesman.

In its version, the House has approved a far more expensive approach, vastly increasing Medicaid payments to all states to pay for the added burden. Massachusetts would get $460 million a year in 2013 and 2014 and $380 million a year after that, the Kerry aide said. But the senator said the high price tag made it politically and fiscally impossible.

``I'd love to get it, but you've got to deal with what's real around here,'' Kerry said.

Representative Michael E. Capuano, Democrat of Somerville, said he would consider withholding support for the final package if Massachusetts does not get extra Medicaid money.

``I want to vote yes, but I cannot vote yes if I honestly believe it will hurt Massachusetts in the long run,'' Capuano said.

A spokesman for Senator Scott Brown, a Massachusetts Republican who opposes the entire health care bill, declined to comment on the Medicaid funding battle.

Newstex ID: BGL-1035-42820753