The New York Times reported on July 19 that the nation’s governors have serious concerns healthcare reform may end with the federal government issuing expensive new Medicaid requirements to the states without providing any funding to cover those mandates. The Times also reported that same day how White House Budget Director Peter Orszag has refused to rule out the possibility that federal tax money could go to funding abortions under current healthcare reform proposals.
The National Governors Association met on July 18 and 19, including a meeting with Health and Human Services Secretary Kathleen Sebelius and Cindy Mann, the federal Medicaid chief. Both Democratic and Republican governors voiced animosity toward any reform that would overload states at a time when they are already struggling financially. “I think the governors would all agree that what we don’t want from the federal government is unfunded mandates,” said Vermont Governor Jim Douglas (R), the association’s incoming chairman. “We can’t have the Congress impose requirements that we are forced to absorb beyond our capacity to do so.”
Douglas’ assessment was backed up even by Democratic governors. Tennessee Governor Phil Bredesen, a Democrat, worried that Congress was about to bestow “the mother of all unfunded mandates.” Bredesen, a former executive in healthcare, said that “Medicaid is a poor vehicle for expanding coverage.” Describing it as “a 45-year-old system originally designed for poor women and their children,” he declared, “it’s not health care reform to dump more money into Medicaid.”
Democratic Governor Christine Gregoire of Washington is concerned that “if we try to cost-shift to the states we’re not going to be in a position to pick up the tab.” New Mexico Governor Bill Richardson, another Democrat, said, “I’m personally very concerned about the cost issue, particularly the $1 trillion figures being batted around.” And Colorado Governor Bill Ritter, Jr. (D) summed things up: “There’s a concern about whether they have fully figured out a revenue stream that would cover the costs, and that if they don’t have all the dollars accounted for it will fall on the states.”
The governors’ consensus of concern is not the only new speed bump for Obama’s rapid pace of reform. While speaking as White House budget director, Peter Orszag was asked if he was prepared to say that “no taxpayer money will go to pay for abortions.” His answer only confirmed the concern of pro-life advocates: “I am not prepared to say explicitly that right now. It’s obviously a controversial issue, and it’s one of the questions that is playing out in this debate.”
By pushing through healthcare reform at a breakneck pace, the Obama administration may achieve what the proposed Freedom of Choice Act has failed to accomplish. State regulations on the abortion industry and federal regulations prohibiting taxpayer funding of abortion could be bypassed under current reform proposals. The proposed public insurance option would include coverage for clinics offering “reproductive services,” and any other private insurance plan would have to follow suit in order to participate in the proposed health insurance exchange. For example, under the House bill, most insurers would have to offer the “essential benefits package” specified by the health and human services secretary. Government would be put in the position of deciding which healthcare services are essential and which are not, a situation ripe for abuse.
The National Right to Life Committee stated: “There is no doubt that coverage of abortion will be mandated, unless Congress explicitly excludes abortion from the scope of federal authority to define ‘essential benefits.’ ” While abortion coverage may not be required specifically, the group believes “federal courts would interpret the broadly worded mandatory categories of coverage to include abortion.” And Douglas Johnson, the National Right to Life Committee’s legislative director, declared that the bill in the House, like the Senate health committee bill approved last week, “would result in the greatest expansion of abortion since Roe v. Wade.”
Reuters reported on July 21 that even President Obama is not happy with current congressional reform proposals, noting what he told NBC's Today show: “Right now, they're not where they need to be.” His reservations are undoubtedly different from those expressed by the states’ governors and national pro-life advocates, but taken together they indicate that the pace of reform should slow down enough to address everyone’s concerns rather than speeding up to make changes that are not well thought out.
One can only hope that the president will use his July 22 prime-time news conference to ease up on his demands for rapid reform, though it is more likely he will again push for a haste that threatens to make waste of America’s healthcare system.