Even before it has held its first meeting, the Bush administration's Medicaid Commission was dealt another setback last week. The National Governors Association said it would not be part of the 15-member panel, after an earlier decision by Democratic lawmakers to also forgo participation.
The reluctance of these two groups to join the effort has thrown into question the viability and credibility of the commission, as HHS Secretary Mike Leavitt works to put it together. Federal budget legislation required creation of the commission to develop a long-term strategy to control Medicaid costs and to find $10 billion in near-term savings.
"The fact that the initial charge is to explicitly find cuts undermines the concept of a commission that is to find solutions for the future of Medicaid," said Judy Feder, a professor and dean of Georgetown University's Public Policy Institute. The decisions by the governors and Democrats "further validates the skepticism of the process," she said.
The NGA's announcement caught HHS by surprise. Christina Pearson, an HHS spokeswoman, said HHS had expected the NGA to be involved in the commission's work and had been looking forward to collaborating with the governors.
In a news release, the NGA said it would support the commission and looks forward to working with it, but given that its Medicaid work group has already completed much of its work, "The members thought it would be most effective to continue their work as an independent bipartisan group."
Late last month, Democratic leaders, unhappy that Leavitt had sole power to appoint all the voting members of the commission, said they would instead craft their own Medicaid legislation. Sen. Max Baucus (D-Mont.) and Rep. John Dingell (D-Mich.) said in a joint statement, "Given the Leavitt Medicaid Commission's lack of independence ... it is difficult to see how this commission would make a significant contribution to the debate on Medicaid."
Some observers said the commission's credibility was always questionable. It was conceived in April when Congress passed its fiscal 2006 budget resolution, which called for $10 billion in cuts over four years beginning in 2007. The original intent was to look at long-term solutions to keep Medicaid financially viable, but once the makeup of the commission became Leavitt's domain, critics began to complain that it would become a puppet of the administration, which has favored Medicaid cuts. The commission's first report, due Sept. 1, must make recommendations on ways to cut $10 billion from the program.
Of the Democrats' decision, Pearson said Leavitt was disappointed but was still "committed to a fair and balanced and open commission ... (and) will continue to seek input and opinions from all parties."
The NGA also last week released an interim blueprint of changes it favors to the Medicaid program. In it, a bipartisan group of 11 governors called for creation of a tax credit for low-income individuals to help pay for health insurance. They suggested increasing rebates from drug manufacturers, changing cost-sharing rules to require beneficiaries to foot more of their bill, and greater scrutiny of beneficiary assets for determining long-term-care coverage. The governors are expected to meet next month to vote on the proposals.