When the state of Oregon wanted a federal waiver for its Medicaid program, what it do? It hired lobbyists to make the state's case to the federal government. Ponder, for a moment, that state governments spend taxpayer dollars on private sector lobbyists hired to lobby the federal government. But don't ponder too long without asking who these lobbysist are, and, more importantly, who they used to be: Turns out they're former federal health policy staffers with experience in both Congress and the Medicare/Medicaid bureaucracy—in other words, people with direct experience running the system from the inside.
Client: State of Oregon
Lobbying Firm: Alston & Bird
Issue: "Assisting the State of Oregon to obtain a waiver for the states Medicaid program."
Lobbyists: Thomas Scully, former administrator of the Center for Medicare & Medicaid Services; and Stephanie Kennan, former health-policy director for Sen. Ron Wyden, D-Ore.
As Carney writes, it's a conveniently rigged system, at least for those who can play: "Congress imposes mandates on other entities, but gives bureaucrats the power to waive those mandates. To get such a waiver, you hire the people who used to administer or who helped craft the policies." It also says plenty about the lack of state flexibility within the Medicaid system: If it was easy for states to get permission to innovate and run their Medicaid programs as they saw fit, then they wouldn't need to hire well-connected lobbyists to help walk them through the process of obtaining a federal waiver.