AHCA's Medicaid Reform Empowers Governors

AHCA's Medicaid Reform Empowers Governors
AP Photo/Evan Vucci

Much of the public discussion about health care and health insurance reform abounds with misinformation. Medicaid, in particular, has become a political tool, with daily posts and articles about reforms to the program that distort the record for political gain. But there is little mention of the need to empower governors to take ownership of the program.

The Medicaid portion of the American Health Care Act (AHCA) is about empowering governors, which is consistent with the 9th and 10th Amendments of the Constitution. We have seen countless examples of governors across the nation making serious strides in policy, tailored to the needs of each states’ citizens. For instance, many governors have opted to raise the minimum wage in their states, including 19 governors who did so on January first of this year. In New York, Governor Andrew Cuomo has implemented the Excelsior Scholarship to give students who meet certain criteria free college tuition to public universities. And here in Florida, Governor Rick Scott has championed Visit Florida to promote Florida as a premier travel destination around the world, helping to create jobs and revenue for our state. 

These are examples of policies that are best executed and administered at the state level, responding to each state’s unique policy priorities and preferences. If states are already empowered to act on wage, education, and economic issues for the needs of their constituents, why should health care be any different? Instead of a one-size-fits-all approach for the whole country, each state should be able to enact and fund the type of Medicaid coverage its voters support and which best fits its demographics.

A health-care system that works in Florida may not work in California or New York. Each state has different socio-economic and demographic compositions. For instance, current Medicaid enrollment in Florida is 21.5 percent of the population, while it is 31 percent in California, and 32 percent in New York. Our population in Florida, with an average age of 41.6, is older than California’s, at 36, or New York’s, which is 38.

Rural and urban areas also have differing health-care needs and delivery system challenges. Under the AHCA, each state’s taxpayers can tailor the care and pricing points to their patients and population. If Floridians have different medical needs than Californians and New Yorkers, why should we be forced into the same health-care program as those other states?

The AHCA offers governors a great opportunity to lead their state governments to take control of its particular version of Medicaid and to give their citizens a stronger voice in the decisions about it, instead of having the federal government tell states what to do. This is the principle of “subsidiarity” — the idea that problems should be solved at the lowest level possible, so that those involved in crafting the solution to the relevant problem are closest to it and thus best suited to devise the most appropriate course of action. 

The real story behind the Medicaid reform contained in the AHCA is about putting decisions closest to those who are affected by it. This is an important step in reducing the often deleterious impact the federal government has on the American taxpayer. It is a return to state-centric Medicaid — the way the program was originally conceived. Most importantly, it will empower the voters of each state to decide what they want and, in so doing, respect the constitutional division of authority established by the 9th and 10th Amendments.

Francis Rooney is the U.S. Representative for Florida's 19th congressional district. He serves on the House Foreign Affairs Committee and the Committee on Education and the Workforce. He previously served as U.S. Ambassador to the Holy See under President George W. Bush from 2005 to 2008.

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