Rhode Island’s Medicaid Experiment Becomes a Talking Point for Budget Cutters

The experiment is the closest to an example of the kinds of changes that Republicans say they want to make — limiting federal spending for Medicaid while giving states more freedom to decide what benefits to offer and how to control the costs.

But an examination of Rhode Island’s experience shows it has not yielded the kinds of savings its supporters claim.

Federal spending on Medicaid continues to rise in Rhode Island, including payments the federal government would not be making otherwise. And unlike a Republican plan that passed the House last month, under which states could lose a substantial amount of federal financing for Medicaid, Rhode Island is virtually guaranteed more money than the state itself has estimated it needs.

Under the experiment, which was born in a 2009 agreement between the state and the federal Centers for Medicare and Medicaid Services, spending on Medicaid was capped at $12 billion through 2013. The state would be responsible for all costs above that amount, rather than sharing those expenses with the federal government.

In exchange, the federal government granted Rhode Island more flexibility in how it runs its Medicaid program.

State health officials predicted the agreement would allow them to offer better and more efficient health care at less cost to taxpayers.

Some Republican governors, members of Congress and conservative commentators have seized on the Rhode Island experiment as proof that the Republican plan to turn Medicaid into a “block grant” program can work. Under such a program, states would get a set amount of federal money to spend on health care for the poor and disabled, along with the autonomy to decide how best to spend it.

Gary D. Alexander, a Republican and former Rhode Island secretary of health and human services, praised the agreement, which he negotiated, in a paper published this year. He said the state had saved more than $100 million in the first 18 months.

But Mr. Alexander’s Democratic successor, Steven M. Costantino, said he “cannot substantiate those savings at this point.”

Still, Mr. Alexander’s estimates have been widely cited by those who support overhauling Medicaid.

Representative Cathy McMorris Rodgers, Republican of Washington State, is the co-sponsor of a plan introduced last week in Congress to lift rules that forbid states from changing Medicaid eligibility requirements. She considers the Rhode Island agreement to be a model for other states, said her press secretary, Riva Litman.

“That plan is supported by both parties in Rhode Island and has saved hundreds of millions of dollars through competition-driven efficiencies and accountability,” Ms. Litman said.

The Rhode Island agreement shares the same goals as the block-grant plan proposed by Representative Paul D. Ryan, Republican of Wisconsin, and contained in the budget resolution that passed the House last month, said Conor Sweeney, a spokesman for Mr. Ryan. The idea is to give states the “freedom to tailor Medicaid to meet the needs of their unique populations,” he said.

“Rhode Island’s experience underscores the positive gains from loosening Washington’s misguided one-size-fits-all approach that ties the hands of too many state governments,” Mr. Sweeney said. “Governors across the country continue to demand less onerous restrictions from Washington so they can better deliver quality, affordable health care to their Medicaid populations.”

During a Senate Finance Committee hearing in February, Senator Tom Coburn, Republican of Oklahoma, also pointed to the experiment in Rhode Island as a success.

“Why don’t we just block-grant every state, take the rules off and let them do these strategies,” he asked. “Rhode Island’s obviously already figured it out.”

Rhode Island’s Medicaid Experiment Becomes a Talking Point for Budget Cutters

The experiment is the closest to an example of the kinds of changes that Republicans say they want to make — limiting federal spending for Medicaid while giving states more freedom to decide what benefits to offer and how to control the costs.

But an examination of Rhode Island’s experience shows it has not yielded the kinds of savings its supporters claim.

Federal spending on Medicaid continues to rise in Rhode Island, including payments the federal government would not be making otherwise. And unlike a Republican plan that passed the House last month, under which states could lose a substantial amount of federal financing for Medicaid, Rhode Island is virtually guaranteed more money than the state itself has estimated it needs.

Under the experiment, which was born in a 2009 agreement between the state and the federal Centers for Medicare and Medicaid Services, spending on Medicaid was capped at $12 billion through 2013. The state would be responsible for all costs above that amount, rather than sharing those expenses with the federal government.

In exchange, the federal government granted Rhode Island more flexibility in how it runs its Medicaid program.

State health officials predicted the agreement would allow them to offer better and more efficient health care at less cost to taxpayers.

Some Republican governors, members of Congress and conservative commentators have seized on the Rhode Island experiment as proof that the Republican plan to turn Medicaid into a “block grant” program can work. Under such a program, states would get a set amount of federal money to spend on health care for the poor and disabled, along with the autonomy to decide how best to spend it.

Gary D. Alexander, a Republican and former Rhode Island secretary of health and human services, praised the agreement, which he negotiated, in a paper published this year. He said the state had saved more than $100 million in the first 18 months.

But Mr. Alexander’s Democratic successor, Steven M. Costantino, said he “cannot substantiate those savings at this point.”

Still, Mr. Alexander’s estimates have been widely cited by those who support overhauling Medicaid.

Representative Cathy McMorris Rodgers, Republican of Washington State, is the co-sponsor of a plan introduced last week in Congress to lift rules that forbid states from changing Medicaid eligibility requirements. She considers the Rhode Island agreement to be a model for other states, said her press secretary, Riva Litman.

“That plan is supported by both parties in Rhode Island and has saved hundreds of millions of dollars through competition-driven efficiencies and accountability,” Ms. Litman said.

The Rhode Island agreement shares the same goals as the block-grant plan proposed by Representative Paul D. Ryan, Republican of Wisconsin, and contained in the budget resolution that passed the House last month, said Conor Sweeney, a spokesman for Mr. Ryan. The idea is to give states the “freedom to tailor Medicaid to meet the needs of their unique populations,” he said.

“Rhode Island’s experience underscores the positive gains from loosening Washington’s misguided one-size-fits-all approach that ties the hands of too many state governments,” Mr. Sweeney said. “Governors across the country continue to demand less onerous restrictions from Washington so they can better deliver quality, affordable health care to their Medicaid populations.”

During a Senate Finance Committee hearing in February, Senator Tom Coburn, Republican of Oklahoma, also pointed to the experiment in Rhode Island as a success.

“Why don’t we just block-grant every state, take the rules off and let them do these strategies,” he asked. “Rhode Island’s obviously already figured it out.”

The Bay Citizen: At Google, the Book Tour Becomes Big Business

At an Authors@Google “fireside chat,” Ms. Fey, the “30 Rock” creator and star, had a friendly conversation with Eric Schmidt, the company’s executive chairman, in front of an audience of hundreds of employees who greeted her with a standing ovation.

As Google’s reach into many aspects of media production and distribution grows ever greater, A-list authors, actors, musicians and others are taking part in the company’s six-year-old on-campus speaker series.

Lady Gaga recently shared the stage with Marissa Mayer, the company’s vice president for location and local services, as did Christy Turlington, the supermodel turned documentary director. The YouTube video of “Google Goes Gaga” has been viewed more than 1.5 million times.

The unlikely spectacle of technology executives chatting up celebrities talk-show-style originated as part of Google’s effort to create a quasi-collegiate atmosphere on its campus. The events increasingly dovetail with Google’s interests in publishing, broadcasting, music distribution and other media businesses. The company is selling “Bossypants” as a Google e-book for $12.99 in its online bookstore, which it opened in December.

For authors and other creative professionals, an appearance at the Googleplex, the company’s sprawling complex of office buildings, is good business — but nonetheless conjures some mixed emotions in light of Google’s complicated relationship with content creators. The company is involved in a bitter lawsuit over its efforts to scan all of the world’s books and make them available online, and has long stood accused of unfairly profiting from work that is excerpted and indexed by the company’s search services.

“I think it’s a great thing that they’re doing this,” Chris Clarke, a natural history and environmental writer, said of the talks. “I don’t think that it clears their karma as far as trying to become the sole-source provider of all intellectual property everywhere.”

The speaker series began in 2005 with the New Yorker writers Malcolm Gladwell and James Surowiecki as its first two guests and has since featured hundreds of authors, musicians, chefs, economists and politicians.

Google employees involved in the program say that it evolved out of employees’ interests and at their initiative.

“The program was a grass-roots effort that started when a few Googlers realized that some remarkable people were passing through the halls of the Googleplex,” said Ann Farmer, an information engineer. She is one of more than two dozen employee volunteers who organize the events, which are now held three to five times a week.

Since 2005, more than 1,000 guests have appeared. Garry Kasparov, the chess master, and Jesse Ventura, the former governor of Minnesota, are among some 600 authors, mostly of nonfiction, who have participated. The list includes a number of authors who have written books about Google.

Talks now take place at Google offices around the world, with employees from 18 offices participating via videoconferencing. At larger events, employees use Google Moderator software, which fields questions from the audience, ranking the most popular ones.

In the early days of the series, the employees had to cajole speakers to attend, working personal connections, since the company did not pay an honorarium. But the program gained traction, with some talks drawing more than a million viewers on YouTube. “Let’s put it this way,” said Ms. Farmer. “The tables have turned.”

As of April 1, Cliff Redeker, 27, is the company’s official “speakers specialist.” He used to organize author visits in his spare time as a support specialist, but now his full-time job is dedicated to the speaker series.

The series has made the Googleplex an increasingly important stop for authors promoting their work in the Bay Area, as many major bookstores that featured readings have closed.

“It’s not going to replace bookstore events,” said Larry Weissman, a literary agent in Brooklyn, “but if I have an author going to San Francisco, I always want my author to stop in at Google and do an event there as well.”

The Google books lawsuit, though, combined with a broader concern that the Internet is undermining the ability of authors to get paid for their work, remains a big issue for some.

As of last October, Google Books had already scanned more than 15 million titles from more than 100 countries in 400 languages. On March 22, a federal judge threw out a settlement agreement between Google and groups representing authors and publishers. The Authors Guild had filed a class-action lawsuit against the company over copyright infringement.