For state govs the far bigger shock to their budgets is the revenue meltdown, relative to Medicaid cost increases founded on enrollment increases. Federal anti-recession aid to Medicaid is conditioned on no shrinkage of eligibility. With the HCR Medicaid expansion and the approaching "cliff" in anti-recession money, states will face another crisis. In aggregate at least, the anti-recession money has been enough to cover enrollment growth, but not revenue losses. A big revenue loss is spread over all state gov functions, not just Medicaid, hence help for Medicaid tends to be diverted to other things as well (in fact, this was intentional on the Feds' part).
CA is a bit of a special case because it is so deep in the hole. Some kind of NYC-type receivership/bailout is in their future.
-----Original Message----- From: lbo-talk-bounces at lbo-talk.org [mailto:lbo-talk-bounces at lbo-talk.org] On Behalf Of Marta Russell Sent: Wednesday, March 24, 2010 12:20 AM To: lbo-talk at lbo-talk.org Subject: Re: [lbo-talk] Cloward-Piven strategy for single payer?
On Mar 23, 2010, at 2:39 PM, Doug Henwood wrote:
On Mar 23, 2010, at 4:51 PM, SA wrote:
> Doug Henwood wrote:
>
>> Of course, in the present environment, this would lead to calls to
>> shred Medicaid.
>
> But the present environment just produced a major expansion of
> Medicaid.
Just wait.
From watching CA make deep cuts to its MediCal (Medicaid) program during this past year I've got to agree with Doug. Given the difficult budgetary conditions facing the state (and other states too), CA's public health care programs are a shaky foundation on which to build a major MediCal coverage expansion. The infusion of federal funds will most likely not fully offset the new costs the state will face in covering more individuals. Even if it does the budget gap will persist and MediCal is one of the first places the cowardly CA legislature gives the axe. These things considered I see more cuts to existing services that will harm those already on the program in order to make room for more people to join- creating a leaner meaner MediCal for all.
I should add that other states have been cutting back on their Medicaid programs too. So I hope those wanting to expand the Medicaid rolls in order to force through a different outcome for health care are prepared to protect the coverage that exists now for people on the program.
Marta
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