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Back across governor frank problem lies and Michael Leavitt.
-- that you administered a state for eight years as governor you double the Medicaid program one of the aspects of obamacare is the a potential expansion of Medicaid.
What are you see -- are the good points and what would be the concerns that you would have.
If you were faced with the decision of expanding Medicaid today under obamacare.
Well I I'm dating myself -- that back in -- dark ages when I was in the state house and senate and there are very few Republicans.
Time you remember the federal government mandated 55 mile an hour speed -- and if he didn't do it you lost money everybody.
At the state level would like to have a free lunch in a check that will clear.
The problem with the Obama care -- -- care expansion -- -- you know -- about sixteen million new people put on Medicaid.
And that will last for about three years and then may be the federal government to pick up the tab when the federal government can't even keep the White House open for tourists.
How would you think that they would be able to pick up the tab so.
I think what we ought to do is let federalism work -- -- on the Rivlin -- -- debt deficit panel.
And what we did among other things is considered block granting.
Medicaid funds to the states let the states decide how much or how little they're going to.
Use those funds and what they should do in terms of the low income and the -- me we don't intend to have.
-- -- pain at the state level that's our grandmother.
We ought to let federalism work resolve these things ourselves but I can understand why the governors think that.
This is free money let's take it and -- worry about it in three years I don't think that's good long term planning.
There there are challenges what do you think about Frank's idea of block granting so the states make all the implementation decisions.
And they applied to the uniqueness of their state because.
At west Virginia's very different -- -- in California.
It it may be -- I just wanna say that if I had the option I would probably take the same.
Position the governor K sick is -- governor Scott -- Republican governors and to sign up for it.
The -- I've tried to actually implement Medicare and SCHIP in a higher level than poverty 138%.
The card obamacare would be.
-- wasn't able to because did not have the resources to do it.
But do think that it is -- set by the calls that that -- reducing the calls of uncompensated care.
-- permitting you're enabling others to get care that wouldn't have you permitting small businesses.
To be able to offer health care to folks that otherwise they couldn't have.
To Frank's point I think -- give me the choice I'll take it perhaps somebody else wall.
By the way let me -- just say to our viewers block -- which is a term we're all kind of familiar with that our viewers may not be.
Means that the federal government would give a lump sum of money and in the states would determine how it's used as opposed to having.
Very specific pipelines that that money has to be use far.
Michael -- not only did you deal with this at the state level as governor but you administrative the entire Medicaid program.
As us secretary of health human services.
Talk about the challenges governors are gonna face in implementing it but what are the dangers if they don't.
Indicated that there were sixteen million more people that would be going on the roles of the welfare -- -- of about Medicaid.
The states are concerned on two counts the first is that because he's also suggested.
They're worried that they the federal government won't be able to pay their share because in order to incentivize the states to do this.
They've agreed to pay almost a 100%.
The second is that they are making eligible for Medicaid people who are currently on private insurance a lot of them.
Because they're going to make eligible family is up to.
Of the poverty line.
They're really making Medicaid which -- been traditionally a safety net program.
Two care for people in need into essentially a social insurance and they're putting a lot of people on who.
By -- -- by any definition I may not be in the in it and are among those in our society here in the greatest need.
All of you helped implement welfare reform which was by -- bodies of imagination and expectation.
A huge success it actually worked it got people off the government dole put them onto payrolls help them get on their own feet.
Why aren't we doing more things like that where at the state level governors are being given the flexibility.
To determine how these programs are actually implemented.
-- this time I'll start with you I'm gonna get an answer from all of the.
Well I think that probably where you're gonna see more of that and -- I see that an education.
With the waiver program 34 states and the District of Columbia now been granted waivers.
From the federal Department of Education from -- provisions of No Child Left Behind so.
In some areas you actually are seeing him in the area that I'm closest to now you are saying.
Where it states abundant are taking the lead and we're going to be learning from them just as we learned -- welfare reform that was the effort by governors.
-- Well obviously if you Warren if you want more something subsidize -- if you want less of something tax it.
We learned that after President Clinton vetoed -- -- reform several times it would we implemented it.
People saw that they had to go to work unless they were physically and mentally incapable of doing so.
They could stand as a human being they have an obligation to work that was a right thing to do that you could not be dependent.
You could not put your feet up and relax you had to get a job and you had to get training for a job.
That is a very good policy outcome whatever the issue might be to -- federalists and work to encourage states to experiment.
To let people -- out of California that if you will because of reckless tax and spending policies.
And go to Mike Levitt's you -- go to my Oklahoma or go to Bob Wise is West Virginia.
That's federalism and I think the more you experiment.
The more you let states decide these issues themselves the -- better outcomes and I'll -- the best outcomes and I did from other states.
Michael Leavitt you're not only are implemented -- that you help but really as an architect of the design it it worked.
Mike I remember when you were governor.
Arkansas and I was secretary of -- you came to me and -- I have an idea.
I'd like to take some of the money that I got from Medicaid I'd like to design a state program I can get thousands of people in Arkansas insurance.
Who -- getting it today with the same money.
That's the kind of innovation that needs to be empowered -- frankly when I was governor I did the same thing there are many ways if you could just turn this to the states.
That they could in fact begin to design programs that are consistent with what they're doing in their state and use the money better.
Well all of you did that analysts say thanks for giving us the model of how good government can be done I hope that the federal government.
We'll turn more to the solutions that are being implemented -- the state level by both Democrat and Republican governors.
And Bob Wise Frank Keating Michael Leavitt thank you all for being here today -- We'll see if we love it together --
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