Hello LeadingAge Missouri Members!
I’m writing this on Valentines Day, so you might expect perspective on relationships. Absolutely! But symbiotic relationships, not romantic! In nature, symbiosis is a close, prolonged relationship between different biological species. Symbiotic relationships can be mutualistic, where both parties involved benefit from the interaction, or they can be parasitic, where one party benefits while the other is harmed.
Neither romantic, nor biological, Medicaid is a political symbiotic relationship between Federal and State governments to deliver healthcare to those who can’t afford it. The Feds provide most of Medicaid’s money and rules, while States orchestrate care delivery. While it’s too harsh to say that the Fed/State relationship is shifting from mutualistic to parasitic, we are seeing Congressional proposals that may disrupt the Medicaid symbiotic partnership.
Congress is beginning Budget Reconciliation, a process that allows it to pass Trump Administration domestic tax and spending priorities with simple majorities in each Chamber (avoiding a Senate filibuster). Reconciliation commences with Budget Resolutions passed by each Chamber’s Budget Committee instructing other jurisdictional House and Senate committees to pass bills (by a deadline) that spend or save designated amounts of money. The separate committee bills are then combined into a multi-billion- or trillion-dollar omnibus bill where the tax and spending policies are collectively voted on. The Trump Administration is committed to reducing the size of government, spurring the economy, ending illegal immigration, balancing the Budget, and shrinking the $36 trillion-dollar national debt. Budget Reconciliation is commonly deployed by both Democratic and Republican Administrations to achieve such policy goals.
As I write, the Senate is pursuing a two-track Budget Reconciliation process with the Senate Budget Committee passing the first of two Resolutions that will cumulatively advance the Trump tax and spending priorities in two subsequent omnibus bills. Because of the slim House majority, the House is pursuing a single Budget Resolution for a single massive tax and spending omnibus bill. The House Budget Committee passed a Resolution calling for $4.5 trillion in tax cuts and $2 trillion or more in spending reductions. Both the House and Senate Budget Committee Resolutions await full House and Senate approval, after which there will be a harmonized House/Senate Budget Resolution, before committees in each Chamber can go to work on the multiple bills that will comprise the final Budget Reconciliation package.
Importantly, the House Budget Resolution instructs the Energy and Commerce Committee to pass a bill saving $880 billion, a level achievable only through substantial cuts to Medicaid spending. Options to substantially restructure the Fed/State Medicaid symbiotic relationship (surveyed here) have been circulating in Congress. All options envision Medicaid cuts at the Federal level with cost-shifting to the States. And all options should concern Missouri government and Missouri citizens who depend on Medicaid. Several of the options would be especially devastating to how Missouri finances its Medicaid program, MO HealthNet.
Another proposal identified by Congress for savings calls for an end to certain tax-exempt bonds. This would substantially disrupt financing for many non-profit healthcare provider projects. Accordingly, LeadingAge, its State Affiliates, and members, are mobilizing to advocate that Congress avoid deep Medicaid cuts and retain tax exempt financing. LeadingAge Missouri members are urged to use this Action Alert link to lobby your Congresspersons.
The Action Alert to Representatives and Senators indicates Budget Reconciliation may also include positive policy changes. LeadingAge is advocating Congress include the repeal of the CMS nursing home staffing rule for budget savings. Budget Reconciliation may also offer an opportunity to increase state allocations of low-income housing tax credits and provide housing credit basis boosts for rural properties and those serving extremely low-income households. LA MO members are encouraged to use LeadingAge’s easy action alert to urge support for these positive priorities and to vote against detrimental changes during the budget reconciliation process. Please act now!
The Budget Reconciliation process is just underway, and Congress is in recess this week. Now is an excellent time to communicate with your Federal Representatives – through the Action Alert or through meetings with Congresspersons while they are home. Your advocacy will make a difference!
Yours in service,
Bill