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Yesterday, Va Gov. Bob McDonnell, Neb. Gov Dave Heineman, and Jack Markell addressed the governor's association conference. This conference took place in the old House of Burgesses just off Duke of York Street in Williamsburg. In the very same room, beneath the same round windows where Patrick Henry, George Washington, James Monroe, James Madison, Thomas Jefferson once debated the merits of independence of breaking away from Great Britain, these three men addressed the governors on upcoming changes to the Medicaid system due to the Affordable Care Act.

From the preamble, one thing was perfectly clear.  Even though the same parties split the association of Governors and those in the hallowed halls of Congress, the inability to compromise and work together, is not present in the Governors Association.  The problem is Congress.
Governors work together and learn from each other.  Whether Democratic or Republican, the primary consistent problem from each and every governor, was the ineptitude of Congress to get things done.  There are many questions today, that need answered.  Partisan rancor has completely stopped Congress from working. That impacts governors as you will hear.

"The worst day in the states is better than the best day in Washington." -- Markell
"The buck stops at the governor's desk. 49 of us have balance budget requirements..... We can't print money."--McDonnell

We would like the Federal Government to make decisions about the budget. We won't agree with it. We just need to know to make our own budgets. = Heineman

"Math is math.  We spend a considerable amount of time looking at the math, and realize there is a considerable cost..... to doing nothing. If people are not covered,... they are going to get care at the most expensive place possible, and that is going to cost all the rest of us with insurance in what is termed uncompensated care.  That cost is quite high... As we run the spreadsheets, this is not political, this is financial, We need to cover 30,000 more people. We are looking at what kinds of resources we can expect from the Federal Government, and what kind cost will be asked of the Delaware taxpayers.  My view is that this could absolutely be a good deal for Delaware taxpayers. For us, this looks to be a good decision. = Markell
"Medicaid expansion without reform is not responsible. ... Two things, we were not expecting.... One that it was decided on a tax and not the Commerce Clause. The other, by a 7-2 ruling the court said it was not proper to penalize states who refuse to expand Medicaid by penalizing their current funding covering their existing Medicaid base... That opens some new options. This gives some options that a lot of us did not be expected to come from that decision." = McDonnell
"We have to move away from a sick care system. where providers are paid on how many procedures they do, to a well care system where they are payed on how well they keep people healthy. Each state can come up with their plan on how to do that. We have a couple of pilots going on in Delaware.  The Medicaid expansion is the right thing in Delaware. We got to move ourselves from the sick care to the health care system. = Markell
"What you are hearing is a great discussion. We are probably going to have 50 different solutions to this problem.  I respect the fact that Jack is going one way, Bob another way, and we are probably going to go a different way." = Heineman.

"It is not all about conflict.  It is about working with each other The impact of the presidential race cannot be overlooked.  I don't want to spend taxpayers money, both federal and state taxpayers money in building an exchange or expanding a program that may look completely different in 6 months. Romney has said, on day one he's scrapping the plan and starting over...." = McDonnell.

"We are 5 months from January 1st. I don't see Congress doing anything till after November elections." = McDonnell

"The President and Congress need to act.  Bob makes a decision every day. Jack make a decision every day. I make decisions every day. The Congress and the President, don't. ... I would like Congress and the President to step up and make these difficult decisions and then go away on vacation for a couple of years."  = Heineman.

"Uncertainty makes it difficult for us as governors. It certainly makes decisions difficult for business executives who are deciding where to make investments.  Trillions on balance sheets around the country are awaiting for a decision from the Federal government in order to determine which way they should go in re-investing in this country." = Markell
"I wish the Federal Government would let each state determine how they want to determine eligibility and distribute the benefits. ... What I need to do in Nebraska is different from what Bob needs to do in Virginia,  and Jack needs to do in DE, not to mention New York, Massachusetts, or California. I would like to see co-pays exist so you got a little skin in the game." = Heineman

"Jack and i agree. There are many things that can be done apart from the federal government within our own states in finding solutions to funding our own problems. But unless we get some federal relief, we are not going to get these reforms done== McDonnell.

"Every governor would like less stings attached to funds that are provided. Too often the Federal government has a certain way the money must be spent. One size does not fit all. Some are meant for big cities that certainly don't apply to rural states like Jack's state or my state. = Heineman

"We need to have answers to questions like what would be the Federal and state ratios be on the insurance exchanges? "= Heineman.

"If all the governors were together I bet we could find a solution. I just wish Congress and the President could do that." = Heineman.

"Your focus is on 2012. Mine is on 2016.. I'm working with these two guys to have a bipartisan party run for president. I'm not sure yet who is going to be at the top of the ticket, but I'm going to be their campaign chairman." = Heineman.

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Comment Preferences

  •  This was a really informative, revealing, and (0+ / 0-)

    fabulous diary.  I sometimes despair of info. below the federal level that yields real discussion of issues affecting all of us.  Thank you! Tipped and recced.

    Cats are better than therapy, and I'm a therapist.

    by Smoh on Sat Jul 14, 2012 at 07:12:04 AM PDT

  •  I am watching the NGA meeting on C-SPAN (0+ / 0-)

    talking about health care earlier today. Unlike the posturing of the governors who propose to reject both Medicaid expansion and state-run insurance exchanges, they are listening to real information from medical professionals about how to fix what is broken in our system.

    One of the most important themes is that we need to pay for results, and not quantity of procedures, visits, and hospital days. That in turn means that we have to do a systems analysis, and invest in a change process. Among other things, we need to reduce the number of patients per doctor; increase nurses and other non-doctor health care personnel; mandate doctor time for phone and e-mail contact; greatly improve medical records handling, including combining records from all providers to a particular patient; finding out why people fail to take medications; and so on. An example was a blind patient who could not see that he was not getting any insulin into the syringe before an injection.

    Story: Governors Discuss Veterans and Medicaid Issues

    Video: The Health and Human Services Committee of the National Governors' Association met to discuss health care and health policy issues facing states. A primary topic of conversation was health care reform, and innovative strategies governors can take to lower Medicaid costs. Additionally, broader aspects of health policy were discussed including hospitals, quality of health services, and emergency response teams. Guests for this panel included Dr. Jeffrey Brenner, founder and executive director of Camden Coalition of Healthcare Providers, Jennifer DeCubellis, director of Hennepin County Health, and David Vellinga, president and CEO of Mercy Medical Center).

    Hands off my ObamaCare[TM]

    by Mokurai on Sat Jul 14, 2012 at 09:59:24 PM PDT

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