In praise of the Nelson deal
Ben Nelson is getting a lot of blowback for the deal he struck exempting Nebraska from paying for its Medicaid expansion. But though it was his deal, it wasn't his preference. It was Harry Reid's. And Reid made the right decision.
"This is the way Senate leadership chose to handle it." Nelson said. "I never asked for 100 percent funding." What Nelson asked for was, in fact, much worse. He wanted individual states to have to "opt in" to the Medicaid program. That would have gutted the Medicaid expansion, at least across the red states, and cost the federal government billions more, because providing subsidies for private insurance is far costlier than providing Medicaid. The eventual price tag would've been far more than $100 million, and the bill's internal structure would be a lot less stable. Reid, to his credit, saw this, and made the problem go away by throwing money at Nebraska.
That's created a few days of bad press, but as Tom Harkin points out, it could eventually lead to good policy. "When you look at it, I thought well, God, good, it is going to be the impetus for all the states to stay at 100 percent [federal funding]," Harkin told reporters. "So he might have done all of us a favor."
Harkin is right about this. One of the best things the bill could do would be to federalize Medicaid, and federalizing the Medicaid expansion is a good first step. Greg Anrig explains why here. That doesn't mean it's not galling that Nebraska got such a sweet deal. But this is the consequence of organizing our legislature around states. Nelson's parochial payoff is a lot closer to the intent of our system than, say, Joe Lieberman's ability to hold the bill hostage to his idiosyncratic and shifting opinions on Medicare buy-in.
Photo credit: AP Photo/Harry Hamburg.
December 23, 2009; 10:36 AM ET
Categories: Health Reform
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