Mississippi's Republican Gov. Haley Barbour has hit a bit of a rough patch on the road to the White House. A Weekly Standard cover story made this Yazoo City native look oblivious to civil rights struggles, albeit, who can begrudge him being more interested in girls as a teen?
Nonetheless, one path to recovery lies smack-dab in the midst of the other crucible every governor, including Mr. Barbour, is suffering: red ink as far as the eye can see.
It's not pretty. Wisconsin's Republican Gov. Scott Walker is facing stiff headwinds - lawmakers on the lam, union members demonstrating, teachers staging sickouts, many displaying precious little comity - all because he proposed cutting state workers' pensions and health care benefits and curtailing collective bargaining to rein in long-term costs.
Collectively, states must close a budget deficit of $175 billion through 2013.
Public-employee benefits - the largest expenditure in nearly every state budget - must be realigned with fiscal reality. Medicaid is another source of out-of-control spending - not only for states but for the feds - that demands urgent attention.
In Mississippi, Medicaid swallowed up $4.37 billion in 2009. California, with the biggest Medicaid tab, spent nine times more.
President Obama, who should be sympathetic to the plight of poor, disproportionately black beneficiaries, has done zip, zilch, nada to reform Medicaid in his 2012 budget. In fact, his Patient Protection and Affordable Care Act, i.e., Obamacare, expands it.
Now that a federal judge in Florida has declared Obamacare unconstitutional, Republicans have a major opportunity to get health care reform right - in a way that doesn't bust state budgets.
It just so happens Republicans have a plan that would save states on average $20 billion annually, a trillion collectively, on Medicaid - the feds $300 million - because it puts patients and their health needs first.
It's called the Patients' Choice Act (PCA). It was introduced in the 111th Congress and featured in House Budget Chairman Paul Ryan's 2010 "Roadmap," which the 112th Congress' 2012 budget will reflect when it comes out April.
Unfortunately, too many Republicanshave withheld their support, if not outright campaigned against this plan because its patient-centeredness not only curbs the power of government bureaucracy, it also curbs the power of insurance bureaucracy.
This lack of Republican unanimity is why Democratsfalsely cast the party as having no plan.
PCA, co-sponsored by Sen. Tom Coburn, Oklahoma Republican, Sen. Richard Burr, North Carolina Republican, Rep. Paul Ryan, Wisconsin Republican, and Rep. Devin Nunes, California Republican - in contrast to Obamacare - would achieve universal coverage and create a true insurance market, thus removing anti-competitive inequities currently plaguing the system.
Most brilliantly, it transforms Medicaid from its current third-rate status into a first-class, stigma-free health care system for low-income people, making it the natural corollary to Republican-crafted welfare reform that President Clinton smartly co-opted in one of the crowning achievements of his presidency.
It does this by tackling health care's structural deficiencies, "realigning how nearly $1 trillion, currently assumed under law, is spent by involving individual [Medicaid] beneficiaries in a way that decelerates the health care spending growth rate, through a carefully calibrated template and formula that emphasizes health outcomes." ("Health Care Reform: The Private Option," Medical Progress Today, Oct. 23, 2009)
In short, PCA brings Medicaid into the 21st century, treating poorer eligible citizens with real dignity for the first time in their lives, and saves immense sums of money while providing a template for reducing health care spending across the board.
The only thing the Patients' Choice Act has lacked is high-wattage leadership.
That's where Haley Barbour comes in and with it a golden opportunity to transform himself into a budget and racial healer, positioning himself to win the 2012 Republican presidential nomination.
Mary Claire Kendall, a Washington-based writer, served in the Department of Health and Human Services under President George H.W. Bush.
Originally published in The Washington Times, 6:22 p.m., Friday, February 25, 2011 (online) and in the paper edition, Monday, February 28, 2011.