The nation's Republican governors, seeking a voice in Congress' upcoming debt debate, pushed Tuesday for looser restrictions on how states spend money on health care for poor and disabled Americans.
States, they argued, should be allowed to design their own Medicaid programs and operate them with a lump payment every year from the federal government, and then be held accountable for the results. Outdated or inappropriate federal guidelines now make it more burdensome and frustrating to provide a health care safety net that's one of the biggest expenses for cash-strapped states, the governors said.
Medicaid should be custom-designed by each state to best provide care to children, the poor and disabled without federal rules and the waivers required to get around them, their report said.
"We should not have to come to Washington on bended knee and kowtow for waivers to do these kinds of things," said Mississippi Gov. Haley Barbour.
The governors, however, plan to come to Washington in October to pressure a select supercommittee of 12 House and Senate members to include the ideas in a plan for curbing the growth of the federal debt.
They're likely to be heard. One of the panel members, House Energy and Commerce Chairman Fred Upton, in May joined Utah Republican Sen. Orrin Hatch in requesting the report. Both are adamant that states should have more control over how Medicaid money is spent.
The document is the most detailed plan yet released by Republican state and territorial leaders, who have long clamored for block grants that they say would save taxpayers billions of dollars, clear away federal red tape, allow them to innovate and improve service.
Politically, it's an acknowledgement of sorts that President Barack Obama's health care law might not be repealed or scaled back by Congress or the courts anytime soon. The 2010 health care overhaul law expands the list of those covered by Medicaid from 69 million beneficiaries now to 95 million over the next decade, a burden the governors say the states can't bear.
The 31 proposals would allow states to do away with requirements set by the federal government on who is eligible and how health care providers are reimbursed under Medicaid. Instead, each state and the federal government would jointly decide the program's goals and Washington would step in only when the targets aren't met.
Oversight would largely fall to the states under state-developed quality and cost guidelines. All federal taxpayer money now directed to combatting waste, fraud and abuse should be included in any state's block grant, the governors proposed.
The waiver process, described by state officials as burdensome, time consuming and often unnecessary, would be, itself, waived for "innovative programs that show a positive return on investment for both the state and federal governments."
The Obama administration has long contended that it built flexibility for the states into last year's health care overhaul and that states will save money with more Americans insured.
Richard Sorian, a spokesman for the Health and Human Services Department, said Tuesday that the Republicans' proposal would "reinstate a broken system" and increase health care costs for middle-class Americans.
"We remain committed to working with governors of both parties to provide as much flexibility in Medicaid as possible while protecting the people it serves," he said.
The report's timing could present its best chance at becoming law. The supercommittee must come up with a debt plan by Nov. 23.
"It's serendipitous," Barbour said. "We think they'll find it helpful."