New Orleans    When the archly conservative National Journal asks whether the Obama Administration is preparing to play hardball with Florida over $1 billion in Medicaid funding that is set to expire later this year for “disproportionate share,” the heart quickens as people, meaning most rational and sentient beings, committed to better health care for all, stand to cheer, “Right on, let’s play two!”  The “disproportionate share” situation unleashes a potentially powerful lobbying force inside the Taliban camps supporting the governors who have stood at the hospital door, blocking the expansion of Medicaid to lower income families as part of the Affordable Care Act, so there’s hope at home, and maybe in Washington.

Here’s the story in a nutshell.

“Disproportionate share” funding is the additional money paid by the feds to a state to subsidize hospitals who are providing a disproportionate share of care to lower income patients, and thereby expected to lose more money in because of uninsured care for such families.  Living in Louisiana, another state with a huge lower income population and a similar coming shortfall of three-quarters of a billion, we all know about “disproportionate share” hospitals because giving them a hand to get started and rake in the extra Medicaid is one of the things that got former Governor Edwin Edwards in so much trouble and eventually in the federal pokey.  Texas is another state in the billion dollar club with disproportionate share payments timing out soon.

The hope for us and the fear expressed by the National Journal is that the Center for Medicaid and Medicare Services (CMS) has already told Florida that there is no way they are going to renew the disproportionate agreement without changes.  Senator Bill Nelson, Democrat from Florida, quoting other conversations indicated that the CMS position was essentially why should they pay for something twice? Here!  Here!  To some degree, hands on the purse strings are already tied, since to fund the Affordable Care Act support Congress had already cut disproportionate share payments by over $18 billion from 2014 to 2020. The Republican recalcitrants have a problem because you can’t rob Peter to pay Paul, if Paul has already lost his money.

Experts say CMS has leverage.  CMS seems to say they are trying to be reasonable.  We should say, as loudly as possible, that it is definitely hardball time.  The National Journal and others aren’t surprised that the Florida legislature is now debating finally expanding Medicaid.  Seems like it is time for some Obama Administration squeeze plays at the plate. They must know that they can’t reward these naysayers, and they absolutely know that lower income families need the additional Medicaid support, so this shouldn’t be about politics, but basic morality.

Organizers everywhere have been looking for a way to rekindle the Medicaid expansion fight.  Here’s a handle and there are a lot of public and private hospitals that are our potential allies on this one.  Now that Obama is starting to be more of the President that we hoped he might be, this seems like one where he should be clapping from the box seats while all of us are cheering from the stands to get the most we can with our leverage now.  I’m for having Secretary Burwell start throwing everything with heat and mixing in a lot of brush-back pitches and maybe a few bean-balls at these hard heads and hearts.

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Almanac Singers – Roll The Union On by Pete Seeger