Tennessee Sen. Lamar Alexander told a joint session of the state General Assembly Wednesday that he still thinks the federal government ought to completely run Medicaid, the national health care program for low-income Americans.
And at the same time, the states should be mostly in charge of running education, said Alexander, a Republican.
During the 1980s when he was governor of Tennessee — and Ronald Reagan was president of the United States — Alexander first floated the prospect of a “swap” as he calls it. “The president liked the idea,” said Alexander. “He recommended it in his State of the Union address, but of course it went nowhere. But if it had been adopted 30 years ago — this grand swap — the state would have come out five billion dollars better in the exchange.”
Alexander added that part of the impetus behind his suggestion, then and now, is that he’s “getting tired of people in Washington making rules that forced me to spend money on Medicaid that I wanted to spend on higher education.”
“Education ought to be local,” said Alexander. “Medicaid ought to have one boss, not two.”
Alexander asserted that such a shift of responsibilities would save states across the country a total of $92 billion a year — roughly $2 billion a year for Tennessee to have on hand to budget with, he said. Alexander indicated he’ll push for the legislation in the Democrat-run U.S. Senate in the coming year.
Making Medicaid solely a federal responsibility “would help to avoid these decisions that the states are having a hard time making about whether to have state (health insurance) exchanges, which include a lot of people on Medicaid — 40 percent of the people on an exchange are going to be Medicaid patients — and the state has to make a decision about whether it wants to expand Medicaid.”
“So if the federal government ran Medicaid, or substantially all of it, it would eliminate that decision,” said Alexander.
Alexander told Tennessee lawmakers that the best thing Washington, D.C. can do in general is stop imposing unfunded mandates on states that “soak up your money and then limit your ability to make decisions.”
State lawmakers on both sides of the generally applauded Alexander’s call for the federal government to refrain from pushing certain policy courses that end up costing state’s money.
House and Senate Democratic leaders took up the theme later in a joint press release prodding statehouse Republicans to embrace the spirit of Alexander’s call for decentralizing governmental decision making.
“We could not agree more with Sen. Alexander, and the same is true of state government,” House Democratic leader Craig Fitzhugh said. “We hope members of his party will take his message to heart when they’re making decisions that cities should make at home.”
Democrats are particularly worried Republicans will continue over the next two years with statewide initiatives on issues like local minimum wage, approving authority for charter schools and application of anti-discrimination policies.
“We should not substitute our judgment for that which is closest to the people,” said Senate Democratic Leader Jim Kyle.