Should Washington take a billion dollars for health care from the feds? Senate GOP leaders say no

Democratic leaders at the state Capitol have been touting an up-to-$1.5 billion waiver from the federal government to pay for new health care programs since it was secured last fall.

But Republican leaders who control the Senate — with the help of one conservative Democrat — are not as excited. They rejected the five-year payout in a budget proposal released last week, citing concerns the state will have to pony up money to continue the programs when the federal dollars dry up.

“We’re very cautious about walking into additional federal funding without fully understanding the long-term costs,” state Sen. John Braun, a Republican from Centralia who chairs the Senate’s budget committee, told media Tuesday.

The GOP plan has drawn criticism from Democrats who say the state should take federal money where it can get it. Washington went through about two years of negotiations with the feds to finalize the deal, said Health Care Authority spokeswoman Amy Blondin.

“It’s better to give something to people while you can afford it than to just say, ‘Oh well, we may not be able to afford it in the future, so we shouldn’t take care of you now when we can,’ ” said state Rep. Eileen Cody, a Democrat from Seattle who chairs the House Health Care Committee.

The Senate’s budget would take a small piece of the federal money that aims to improve long-term care services, in part by helping people get help at home rather than in medical facilities. But Blondin said the Legislature can’t approve only parts of the agreement, which comes in the form of a waiver from the government health care program for low-income people known as Medicaid.

“We would have to go back to the table and renegotiate the whole waiver,” she said.

The waiver comes with two buckets of money in addition to the long-term care dollars. One aims to help people using Medicaid find and keep jobs and housing, Blondin said.

The other chunk of the waiver would pay to better merge physical and behavioral health treatment in the state, including a focus on fighting opioid addiction.

Blondin said when the waiver is finished, lawmakers would have to decide if they want to continue aspects of the program. The HCA expects the state can keep the services without any new costs because of money-saving reforms built into the programs. But extra state money may be needed to sustain some of them.

Braun isn’t the first Republican state lawmaker to express concerns over accepting federal health care money. Some GOP legislators have argued against the state’s choice to expand Medicaid eligibility under the Affordable Care Act and take billions in federal money, saying the dollars may not always be there.

The state is scheduled take on more Medicaid expansion costs in coming years as part of the health care law.

More than 600,000 people in the state have health care coverage from the Medicaid expansion, which began providing benefits in 2014. The Legislature approved the expansion with the help of the GOP-led Senate.

Braun said his budget plan wasn’t directly influenced by the congressional debate over repealing the ACA and its Medicaid expansion.

But, he said, “before you expand programs you’re going to fund long-term with state dollars, we should be really careful with how we walk in there.”

“Free federal money is never as free as it sounds,” Braun said.

Cody said she still expects the Medicaid waiver to be in a final budget compromise later in the legislative session since it is a priority for Democrats.

“Do I think we probably would end up paying for some of it? Yes,” she said. “But it’s things that I think will help us.”

This story was originally published March 31, 2017 at 1:04 PM with the headline "Should Washington take a billion dollars for health care from the feds? Senate GOP leaders say no."