Word: deale
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...wonder that the sweetheart deal Senator Ben Nelson got for his home state of Nebraska as part of the Senate health reform bill has caused such consternation among his colleagues. In exchange for his vote, say critics, Nelson was promised that the Federal Government would pay 100% of the cost of expanding the Medicaid program in Nebraska. The 49 other states, by contrast, would have full federal funding for a few years but would eventually have to pick up part of the tab. As soon as word of the special treatment broke, the deal became known as the "Cornhusker Kickback...
...wake of the attacks, Nelson has done his best to deflect attention from the special arrangement. He insists the deal wasn't his idea, and, in a Jan. 15 letter to Senate majority leader Harry Reid, Nelson asked that special treatment for Nebraska be excluded from the final legislation. In the same letter, however, Nelson repeated something he has been saying since word of his special deal got around - that newly eligible Medicaid enrollees in all states should be fully and permanently paid for by the Federal Government. At first, this seemed like a crude and overly expensive solution...
Helping states by extending the Nebraska deal nationwide or by upping federal contributions to future Medicaid costs would certainly relieve some unwelcome pressure. Along with Schwarzenegger, who had previously been a reliable Republican proponent of Democratic health care reform, many other governors - including New York's David Paterson, a Democrat - have publicly protested the legislation on the basis of the Medicaid expansion, saying it amounts to an unfunded mandate. In addition, at least 13 state attorneys general have said Nelson's special deal is unconstitutional. But extending the Cornhusker Kickback to all 50 states would be a lot more than...
...billion limit set by President Obama. Then again, House and Senate leaders are currently negotiating all sorts of adjustments for a merged bill, and any new Medicaid costs could be part of that calculation. "Having the Federal Government pay the complete thing is not that big a deal," says John Holahan, an economist who has studied the Medicaid expansion extensively and who is also director of the Health Policy Research Center at the nonprofit, nonpartisan Urban Institute...
Aside from the financial feasibility of extending the Nebraska deal to all states, there could be far-reaching policy implications of such a move. In contrast to Medicare, the other massive public insurance program, which is funded and run by the Department of Health and Human Services (HHS), administration of Medicaid has historically fallen to states. This has given governors and legislatures the flexibility to structure their Medicaid programs based on their populations and budgets. States now determine who qualifies for Medicaid, what's covered by the program and how much doctors and hospitals get paid for taking care...