Capitol to Capitol
An Information Service of NCSL's Standing Committees

Volume 17   Issue 24 - June 18, 2010


MEDICAID MATCH....WAIT UNTIL NEXT WEEK. Please note that negotiations remain underway on various elements of H.R. 4213 as NCSL distributes this issue of Capitol to Capitol.

There were two attempts this week to invoke cloture and thereby limit debate and amendments on H.R. 4213, legislation that would provide states with a six-month extension of the enhanced match for Medicaid and Title IV-E programs initially authorized in the American Recovery and Reinvestment Act. Both attempts failed, indicating that there is still insufficient support in the Senate to hit the 60-vote procedural threshold that would lead to a final vote on H.R. 4213. The first attempt failed 45-52, with some members expressing concerns over the funding levels of the legislation, or the lack of sufficient offsets, or various provisions of H.R. 4213. Montana Senator Max Baucus introduced a revised amendment to the underlying bill that reduced its spending size to $118 billion. He included sufficient revenue modifications to cover over half of the entire bill. And, he retained the full $24 billion for the enhanced match increase for states. Despite these revisions, supporters came up short 56-40. South Dakota Senator John Thune argued for passage of his alternative, which excluded the enhanced match and Temporary Assistance for Needy Families (TANF) Emergency Contingency Fund extensions; but it came up on the short end of a 41-57 vote.

Attempts were made late Thursday evening to move only those provisions extending unemployment insurance benefits and blocking a schedule reduction in Medicare physician reimbursements (the “doc” fix),but Democratic and Republican leaders could not reach a final agreement on this alternative.

Today, Senator Baucus and Iowa Senator Charles Grassley reached accord on legislation (H.R. 3962) that extracts the “doc fix” from H.R. 4213-- delaying for six months the scheduled 21 percent reduction in Medicare physician fees. The Senate passed the legislation under unanimous consent before recessing for the weekend. All other issues, including the enhanced match extension, remain on the table. Please note that the House of Representatives has recessed for the weekend and will not be in a position to take up H.R. 3962 until next week.

Remaining elusive is some concrete indication regarding the level of spending and level of offsets that can garner enough support to attract 60 votes. During negotiations this week, any extension of COBRA premium subsidies and the $25 per week additional unemployment insurance benefit fell to the wayside. There were hints that the $24 billion for the enhanced match extension would be partially reduced or subjected to a phased down amount over the period of January to June, 2011.

NCSL will continue to post updated information to its webpage in order to keep you current on this issue. (NCSL staff contacts: Joy Johnson Wilson, Rachel Morgan (Medicaid), Michael Bird, Jeff Hurley (fiscal issues generally), Sheri Steisel, Lee Posey (TANF).

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