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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.

By Ezra Klein  |  December 23, 2009; 10:36 AM ET
Categories:  Health Reform  
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I rise today to associate myself with the comments from our dear blogger on Medicaid funding. The sooner we can break the state's "partnership" with the federal govt on Medicaid the better, its a good step toward the eventual single payer system.

Also, my sense is removing the state from the equation would relieve the states of the huge burden of it, as well as streamline the bureaucracy by having Medicaid be a federal program.

Now, people who worry deep into the night about deficits will respond, my God the horror, funding Medicaid 100% at the federal level will destroy the country with spiraling debt et al, my pre-emptive response would be this is really more like consolidating your credit cards at a low interest rate, since we've made the entitlements and are currently funding them partially out of state budgets at higher interest rates than the 10- and 30-year treasuries.

Posted by: zeppelin003 | December 23, 2009 10:50 AM | Report abuse

Klein is really turning into the biggest tush-licker for anything that Democrats do, no matter how corrupt. And don't you love how he manages to unite this transparent piece of spin with yet another episode of his Lieberman derangement syndrome.

Posted by: WashingtonDame | December 23, 2009 11:05 AM | Report abuse

More federal welfare for a red state. Typical. I'll keep this deal in mind the next time somebody from the "Real America" lectures me about personal responsibility or private enterprise or whatever it is blue states don't have.

Posted by: simpleton1 | December 23, 2009 11:26 AM | Report abuse

Having come to accept the process of "buying votes" as de rigueur for the legislative process, I was puzzled (and amused) by the Republican display of righteous indignation about it in the Senate yesterday, John McCain being the MOST vocal and most indignant.

Isn't "buying votes" equally practiced on both sides of the aisle?

Was there something uniquely galling about the deals Harry made? Or were Republicans simply angry that, this time, the deal was done by the other side of the aisle? Or was it simply a seized opportunity for more C-Span theatrics?

Posted by: onewing1 | December 23, 2009 2:16 PM | Report abuse

The problem with full federal funding for Medicaid is that certain states circumvent the horror that is the Hyde Amendment by providing full abortion funding out of the state monies. A federalized system is going to mean that vulnerable urban populations in blue states with governments that recognize women as full and equal citizens with the right to control their own bodies are going to lose the abortion coverage they have. And that's not exciting at all.

Posted by: bmegli | December 23, 2009 4:58 PM | Report abuse

This is moronic. Bribery is bribery, and this column defends the indefensible. Good riddance, WaPo. Your imminent failure is due to publishing lefty crap like this.

Posted by: randall_carter | December 24, 2009 11:05 PM | Report abuse

Ben Nelson is a traitor. He is Nebraska's Benedict Arnold. He traded his principled career, popular ex-governor, to grovel at the feet of Harry Reid. Arnold got a commission and pension with the English army. He died in shame, his wish on his death bed was to be dressed in his Colonial uniform. Ben Nelson signed his name to legislation that use public money to murder of babies in the womb. He signed his name to a deal that steals billions of dollars from other states to bail out his state's Medicaid program -- for infinity. Ben Nelson is a traitor. He deserves our scorn and hatred, not unlike Benedict Arnold, a brilliant general who sold out his country for a commission and pension.
``We're mad as hell and we're not going to take it anymore.'' The people inside and outside Nebraska are going to track down Ben Nelson, brand him a traitor, and end his career in public service. You think Sarah Palin had a tough run of it. You ain't seen nothing, Benedict Arnold Nelson.

Posted by: hedgehog1 | December 24, 2009 11:05 PM | Report abuse

Why comment on a juvenile's column. He obviously is wet behind the ears and hasn't ready his history lesson. What a fool.

Posted by: rchaa27aa | December 24, 2009 11:29 PM | Report abuse

this bill is unconstitutional the people in florida pay less for medicare advantage if congress past a law taxing republicans higher everyone would know that this is the same thing the government can not make you by something to be a legal citizen and madam speaker we are serious where does the constitution give congress authority to do this oh but canada and england love here's my 3 year old grandson loves a big cardboard box he can pretend it's anything health care is not pretend canada health care is a leach on the usa they are only 30 million people there is 1 hospital in texas that spends more money on research than canada sacramento has more mri's ct scanners than canada oh the drugs are cheap in canada well the drug companies dump there seconds there are they will have to pay full price now cut the doctors pay 21% lets start with the senate can you imagine they had to work a hole 24 days this month what slavery oh wait everyone else does that every month just to pay our outrageous taxes you want to wait 6 months for a mri or ct scan i don't but you don't care you think is FREE that it you are still alive or are now stage 4 breast cancer we have drug to fix that but costs alot and you are 65 and live long enough to pay taxes to cover it so go home a die move to a new town in canada well you wait a year to maybe get one you know they have lotteries every month to see who gets a new doctor this socialism marxism that fails everywhere it's tried

Posted by: m0j0 | December 25, 2009 4:24 AM | Report abuse

mr klein want color is the sky on the planet where you live and have you ever learned any history or economics?did you go to school

Posted by: m0j0 | December 25, 2009 4:29 AM | Report abuse

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