HR 5613: Huh?

HR 5613: Huh?

If you want to know how big and complicated public policy is, HR 5613 currently before Congress is a good example. I'm generally skeptical of federal spending on direct aid to the poor, for the simple reason that this is properly the job of the states. But the complexity of the Medicaid regulation changes that HR 5613 is trying to stop just makes my head spin.

As near as I can figure out, Congress passed something called the Deficit Reduction Act of 2006, which was supposed to reduce Medicaid spending on certain programs. The claim that this leftish bunch makes is that the Administration's new regulations go far beyond Congressional intent. Some of these changes are very basic and important questions; others are fairly complex regulatory changes that certainly make a difference, but I am not finding any statements of costs or benefits:

All of the regulations will shift costs to states and localities by limiting federal support for services that have typically been supported partly by federal funds and are widely seen as important and necessary.

For example, one regulation will eliminate all federal matching funds for various Medicaid-related activities designed to help low-income children — such as outreach, enrollment assistance, and health care coordination for these children — if the activities are performed by school personnel. The Administration concedes that these are proper activities in support of Medicaid; it simply does not want to help pay for them any longer when a state Medicaid program contracts with schools to provide them.[9] This is a sharp departure from longstanding Medicaid practice. In fact, in 2000, three federal agencies published a guide to school-based health outreach noting that schools represent the “the single best link” for identifying and enrolling eligible low-income children in public health coverage.[10] It also is inconsistent with statements the Administration issued when vetoing children’s health legislation last year that the Administration wants states to reach and enroll more of the poor children who are eligible for Medicaid but are uninsured.

And what, exactly, does this mean?

If "outreach" means that we are paying someone to run around looking for low-income children who aren't currently insured, and making sure that they are insured, I cringe just a little--salaries are expensive, and if there isn't enough real work to do, bureaucrats are known for going and looking for ways to spend more money on whatever good deed they think will make their position secure.

If it means making the information readily available to poor people so that they are aware that they are eligible for Medicaid, this doesn't bother me. Printing flyers, perhaps putting together a public service announcement, and persuading radio and TV stations to run it for free, isn't so expensive.

And this is just one part of the Medicaid regulatory changes that HR 5613 is supposed to delay for a year. I fear that I would have to invest a lot of time and money in figuring out exactly what the proposed changes do. These are the kind of nitpicking details where you start to have to rely on people that you trust to tell you what is really going to happen--and this assumes that they are both honest, and genuinely knowledgeable about what is going to happen.

The National Alliance on Mental Ill wants HR 5613 passed because there are a number of services for the low-income mentally ill that they think will be damaged by the regulations that are scheduled to take effect soon. That inclines me to think that whatever the intentions of these Medicaid regulation changes are, the effects will be bad for the mentally ill.

This report from April 18, 2008 Medical News Daily (a British publication) indicates that HR 5613 enjoys remarkably bipartisan support--passing out of the House Energy and Commerce Committee 46-0. If this had passed on party lines, or if there were a number of votes against (on either side of the aisle), I would wonder if there might be a strong argument in favor of the proposed regulations, and against HR 5613. I find it hard to believe that every single Republican on that committee is a squishy liberal.