Govs. break NGA ranks on Medicaid

The Bush administration has shattered the National Governors Association’s (NGA’s) unified front in the ongoing debate about the future of Medicaid by successfully courting two governors to participate on a controversial panel.

The Bush administration has shattered the National Governors Association’s (NGA’s) unified front in the ongoing debate about the future of Medicaid by successfully courting two governors to participate on a controversial panel.

Florida Gov. Jeb Bush (R) and West Virginia Gov. Joe Manchin (D) have agreed to sit on the Department of Health and Human Services’ (HHS) Medicaid Commission, which wraps up a two-day meeting today. HHS announced the new panel members Tuesday.

The NGA had rejected offers to participate in the process despite the administration’s holding open two seats on the panel. The governors instead have worked independently to develop recommendations to the White House and Congress about how to reform Medicaid, which has become a major drag on state budgets. HHS Secretary Mike Leavitt assembled the panel after Congress authorized it in the fiscal year 2006 budget resolution.

The defection of two governors from this formerly unanimous position could lend an air of credibility to the Medicaid Commission, which had been shunned not only by the governors but also by Congress.

It also represents the latest rift between the Bush White House and the NGA as administration proposals on reshaping Medicaid have set off a number of public and private disputes.

Manchin professed to being unaware of the NGA’s position until being informed by a reporter and added that he never thought about how other governors or congressional Democrats would react to his decision.

“I’m not privileged to [know] the Beltway politics,” he told The Hill yesterday.

Manchin’s move could be viewed as an apostasy by some governors and by his party’s leadership in Congress.

“I haven’t been chastised by anyone,” Manchin said.

In addition to the NGA’s shunning the commission, congressional leaders in both parties chose not to name members of Congress to sit on the panel as nonvoting advisers, as they were entitled to do under the budget resolution. Congressional Democrats forcefully dismissed the entire process as a rubber stamp for the administration’s already-established positions on Medicaid.

Sen. Jay Rockefeller (W.Va.), who is the Senate Democrats’ point man on Medicaid reform, spoke out last week upon learning of Manchin’s decision.

“Congressional Democrats are not participating in this commission because the Bush administration refused to assure us that it was about anything other than making billions in Medicaid cuts,” he said, according to the Charleston Gazette, which first reported that Manchin would join the panel.

The cooperation of Bush, a conservative Republican and the president’s brother, will surprise few in Washington. Moreover, the administration recently approved Florida’s request to use private health-insurance companies to administer Medicaid for more than 2 million of the state’s beneficiaries. The Florida program could be a harbinger of the direction in which the administration wants to take Medicaid.

Bush, whose home state is reeling from Hurricane Wilma, did not attend the meeting. A call to Bush’s office was not returned.

Manchin said he spoke with Virginia Gov. Mark Warner (D) yesterday and has been trying to reach Arkansas Gov. Mike Huckabee (R); Warner and Huckabee are leading the NGA’s Medicaid-reform efforts. Manchin did not discuss his decision with other governors until after informing Leavitt that he would join the commission, said Lara Ramsburg, his communications director.

Warner “understands that [governors] have to be involved” in the Medicaid-reform process, Manchin said. Having sitting governors on the panel “would be a plus for all governors,” he predicted. “The system is going to change and probably should change,” he added.

West Virginia has an application pending at HHS to allow the state to make changes to its Medicaid program. “That’s my main concern,” he said. Nonetheless, he emphasized, “There was no strings attached when I was asked to serve” nor a “litmus test” about his views on Medicaid reform.

Manchin based his decision on his assessment of the best interests of West Virginia, Ramsburg said. “He really sees it from a West Virginia perspective,” she said Tuesday. “The needs of the state … need to be of the utmost concern.”

Leavitt approached Manchin about the commission earlier this month. Manchin concluded that sitting on the commission would provide “an opportunity for West Virginia to have a voice,” Ramsburg said. The state’s top Medicaid official, Nancy Atkins, already is on the panel.

The commission issued a report in September — only two weeks after its first meeting — and is planning to release a set of recommendations on long-term Medicaid reform by Dec. 31, 2006. The budget-reconciliation bills that passed through the Senate Finance Committee and the House Energy and Commerce Committee both include some Medicaid cuts similar to those espoused by the commission and by the NGA.

As originally conceived by Sens. Gordon Smith (R-Ore.) and Jeff Bingaman (D-N.M.), the commission would have been independent of the administration and explicitly bipartisan. Smith rejected a request by Majority Leader Bill Frist (R-Tenn.) to sit on the panel.

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