Sorting fact from fiction on Romney and RI’s Medicaid waiver

WPRI.COM

Ted Nesi

Updated: Oct 24, 2012 3:26 PM

Excitement ricocheted across Twitter Monday night when Republican Mitt Romney mentioned Rhode Island in one of his debate answers, a rare presidential-level cameo for this deep-blue state.

Echoing a frequent talking point from conservatives, Romney pointed to the Medicaid waiver that the outgoing Bush administration granted Governor Carcieri in early 2009 to explain why he wants to give states more control over the program.

“States like Arizona, Rhode Island have taken these, these Medicaid dollars, [and] have shown they can run these programs more cost-effectively,” the former Massachusetts governor said.

As the chart at right shows, Rhode Island has one of the most expensive Medicaid programs in the country, which partly explains why local policymakers have been so intent on finding ways to curb its costs. Yet the impact of the waiver remains in dispute nearly four years after it was approved.

Romney’s comments have led to a flurry of fact-checking, particularly from liberals who oppose Republican proposals to block grant Medicaid. Politico’s Jason Millman weighed in Wednesday with a story questioning Romney’s claims (emphasis mine):

The Romney Medicaid plan would cap the growth of the program’s spending to the consumer price index plus 1 percent and essentially give states a lump sum to spend as they see fit. The Rhode Island and Arizona Medicaid programs, while enjoying more flexibility, are still backstopped by the federal government. …

In the case of Rhode Island, the Global Waiver it obtained in 2009 wasn’t intended to control costs, as a Lewin Group report commissioned by the state explained last December. “The Global Waiver is not a block grant meant to control costs but a demonstration aimed to improve health care quality built on the core foundation of shared state and federal costs,” the report said. …

The Lewin report said it was too early to assess the full impact, but it did find the Global Waiver had saved about $23 million in the first three years — well short of the $100 million in savings predicted when President George W. Bush’s administration approved the waiver.

Health and Human Services Secretary Steven Costantino gave a mixed verdict last year. “I think many of the things we could’ve done without the waiver,” he told McClatchy. “The more important question is, would we have done it?”

To get the case for the Medicaid waiver’s importance, read the Ocean State Current’s Justin Katz, who highlights a key piece of context – the waiver went into effect in January 2009, when the economy was in a tailspin. Within a month that led President Obama to sign the stimulus law, which had a significant impact on Medicaid spending in every state, including Rhode Island. The months after the Medicaid waiver went into effect were not a normal policymaking period.

To get the case against the waiver as a national model for block grants, read the Center on Budget and Policy Priorities’ Jesse Cross-Call and Judith Solomon’s March 2011 study and their March 2012 follow-up. For a shorter summary, try Cross-Call’s new blog post: “The Truth Behind Rhode Island’s Medicaid Waiver.”

(chart: Center on Budget and Policy Priorities)

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