I can’t read the whole thing yet, since it’s hiding behind the Wall Street Journal’s paywall, and I’m not about to subscribe. But from the headline and lede, it seems Sen. Lamar Alexander (R-TN) has taken a long stroll down memory lane by resurrecting the one-fashionable idea of a “swap” whereby currently shared federal-state governing responsibilities would be divided. In particular, he proposes that Medicaid be taken over by the feds in exchange for total assumption of responsibility for education by the states, and mentions he tried to sell the idea to Ronald Reagan back in the early 1980s.
I don’t know exactly which meetings Alexander is talking about, but as it happens, I was working for the then-chairman of the National Governors’ Association, the late Georgia Democratic Gov. George Busbee, when he was leading “federalism” discussions with the Reagan folk in 1981. Most governors at the time, regardless of party, were interested in what was called a “sorting out” agenda that would federalize some programs and devolve others; this was a favorite topic in particular for Arizona’s Democratic Gov. Bruce Babbitt, who like to talk about “states’ rights for liberals.” Babbitt wanted a “grand swap” in which Washington would become responsible for all health care and “welfare” programs in exchange for state assumption of transportation, education and criminal justice, areas in which they were already the major funders and policymakers. My own boss had a similar approach, but was mainly concerned to head off the kind of one-way abandonment of federal responsibility that most conservatives had in mind when they talked about “federalism.”
Whatever they told Alexander, that was pretty much the tendency of the Reaganites of the day. Reagan’s famous OMB director, David Stockman was interested in a “swap” that would have devolved cash income support, food stamps, and health care for the poor in exchange for the feds taking responsibility for the health care needs of seniors who were “dual-enrolled” in Medicaid or obtaining long-term care subsidies. It was basically a “swap” of old folks for poor folks. The governors weren’t buying it, and in any event, the Reagan administration was simultaneously pursuing a budget that would “cap” federal Medicaid payments, basically intitiating the kind of gradual shift in responsibility for the program to the states that Paul Ryan is pursuing in a more comprehensive way with his proposal to turn Medicaid into a “block grant.” As it happened, the Medicaid “cap” was one of the few budget proposals Reagan lost on in 1981.
Best as I can recall, this was the high-water mark of national Republican interest in taking over Medicaid, and it obviously was lower than a snake’s belly in a wagon rut. It’s only gotten worse sice then. It is striking that ol’ Lamar is talking about a federal takeover of Medicaid even as he joins other Republicans in violently opposing ObamaCare, since one major feature of ObamaCare is a significant increase in federal responsibility for Medicaid (via higher match rates for new enrolees), and for the health care needs of low-income families generally.
The bottom line is that Alexander is really living in the distant past if he thinks his party will support federalization of Medicaid (unless they get the idea they can starve or abolish it). The prevailing sentiment in the GOP, as reflected in the Ryan budget, is to move towards devolution of all current federal-state programs to the states, via rapid funding cuts to non-defense discretionary programs and by turning Medicaid and food stamps into block grants (along with big funding cuts). Matter of fact, Alexander voted for the Ryan budget himself. Maybe he explained that little contradiction in the portion of his op-ed still behind the paywall. Or maybe he’s just having a senior moment.
