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A tale of two reports: more on Gary Alexander

February 1, 2011

In case you’ve forgotten, a report by RI’s former secretary for the Executive Office of Health and Human Services raised some eyebrows a few weeks ago for making unauthorized  claims about RI’s Global Medicaid Waiver.  His report appeared on the website of the free market think tank the Galen Institute.

But now it appears that there were two reports- the  current one posted in January and another, featuring stronger language and some different numbers, posted at some point last year.

Here’s a sampling of  the major differences-

Quote opening the report

Current version: “Government should cost the least and do the most.” Thomas Paine, Common Sense

Old version: In the Federalist papers #45, James Madison declared that the federal government’s “jurisdiction extends to certain enumerated objects only, and leaves to the several States a residuary and inviolable sovereignty over all other objects.”

Opening sentence

Current version: The United States is on a long-term unsustainable budgetary path.

Old version: Irrespective of the latest binge of federal spending, the U.S. was already on a long-term unsustainable budgetary path.

Rhode Island’s place in history

Current version: Rhode Island has already paved the way to reforming entitlements by crafting and implementing the most sweeping entitlement reform in the nation…

Old version: Rhode Island, the most liberal state in the union, led by a few brave conservatives has already paved the way to reforming entitlements by crafting and implementing the most sweeping entitlement reform in the nation…

The changes go on…

In some cases, it’s a few altered words.  In other cases, entire paragraphs from the old version are deleted.  Like this one, talking about how the waiver allowed RI more discretion in how to spend its federal Medicaid funds-

…the CMS bureaucrats were concerned that if this type of flexibility were granted, many of their positions might not be necessary. One CMS bureaucrat argued, “if we give you [Rhode Island] this amount of flexibility, what are we supposed to do; we might lose our job because we have nothing to do.”

There’s also a discrepancy when it comes to Alexander’s estimates about the amount of money saved by the waiver.  The earlier report offers these figures-

The numbers in the current report are completely different-

The Pulse obtained a copy of the earlier report from the Center on Budget and Policy Priorities(CBPP) – a policy group that conducts research and analysis on how policies affect low income residents.  CBPP closely followed the creation of RI’s global medicaid waiver and  is monitoring the effects of Alexander’s report.

Jesse Cross-Call with the CBPP can’t say for sure, but he thinks the original report appeared on the Galen Institute’s website at some point in November or early December.  It might have come out on December 1st- that’s when Alexander is mentioned in a health reform report entitled “‘States preparing to fight back against ObamaCare.”

Other governors are looking at the success of Rhode Island which was granted a waiver from the Bush Administration in January of 2009 to receive its Medicaid funding as a block grant rather than a federal match for Medicaid spending. The result: The state saved $150 million in the first 18 months. The state’s Health Secretary Gary Alexander says the savings from Medicaid were “the sole reason why Rhode Island possessed a state budget surplus in 2010.”

The $150 million in savings quoted here is $40 million dollars less than the savings mentioned in the most recent report, which modifies Alexander’s language to call the waiver “one of the reasons” why RI had a state budget surplus in 2010.

Why does Alexander’s report matter? The Center on Budget and Policy Priorities is interested in his claims becuase Alexander invites  other states to try the same experiment.  Judith Solomon with CBPP says it’s unlikely it’s even possible for other states to receive a similar global waiver for a few reasons-

1. Different political climate

RI’s Global Waiver was approved during the waning days of the Bush Administration.  It’s unlikely the Obama administration would support this approach, especially with other ways to create similar changes under the health care overhaul.

2. The federal government lost money on the waiver

The estimates for RI’s trend rate ( how much money the state would spend on Medicaid over time) was overly generous and included the ability to spend federal money on items the state used to pay for on its own before (these are called CNOMs- Costs Not Otherwise Matched.) So Rhode Island actually gained some extra cash out of the deal- something the federal government is unlikely to offer in the future, given its initiatives to cut spending and reduce the national debt.

But it’s possible Judith Solomon’s observations (and reports from The Pulse) have had some impact.  A search for “Gary Alexander” on the Galen Institute’s website no longer features his report.  Alexander still hasn’t returned my calls seeking comment.

Update– The latest version of Alexander’s report no longer features the state seal.

5 Comments leave one →
  1. William permalink
    February 1, 2011 2:03 am

    Thank you, Megan, for pursuing this and exposing Mr. Alexander’s twisted and ideologically-driven “analyses.”

    Obtaining the Global Waiver, as Ms. Solomon pointed out, was purely a result of timing. A flailing Carcieri administration, looking for a quick fix, cynically joined with the outgoing Bush administration in a scheme that is all about cooking the numbers. Whatever “savings” might be shown in the early years of the waiver (and they are suspect), Rhode Island will most assuredly be on the hook in the out years when we have reached the cap and, thanks to Bush’s economy, more people than ever need Medicaid’s help. Under the terms of the waiver, they’ll be out of luck. Regardless of which Alexander report you read, it is a very bad deal.

  2. Craig permalink
    February 1, 2011 4:54 pm

    Megan – thanks for the good reporting on this. the state of RI is in bad shape in part because Carcieri administration officials, including Alexander, misreported all sorts of things over the eyars, trying to look good while screwing up the state budget, not to mention the lives of tens of thousands of RIers who relied on services. Hold his feet to the fire – and hope someone in Pennsylvannia is paying attention.

  3. Dawn permalink
    February 16, 2011 2:19 pm

    Nice work, Megan!


  1. Wall St Journal praises RI’s global Medicaid waiver « The Pulse: health care in RI

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