I'm tired of people referring to the Senate health care bill as containing a back room deal that benefits Mary Landrieu. Several conservatives like Beck and Limbaugh have called the deal "the Louisiana purchase" and they've labeled Landrieu a prostitute for selling her vote for money.
Instead, the reality is pretty simple, and it has to do with FMAP, or "Federal Medical Assistance Percentages." Louisiana is a relatively poor state, and as such, we receive a higher percentage of federal funds to cover Medicaid than wealthier states. Landrieu's "deal" was simply a one time fix for a sharp drop in federal Medicaid money because of a temporary surge in income when Louisiana residents received recovery dollars after the 2005 hurricanes.
For example, in 2006, Therese and I had a combined income of about $90,000. That year we received $150,000 in Road Home money. This made it appear to some government officials that our income was $240,000, and so less federal Medicaid money was sent to the state. However, all of the $150,000 and more went to fixing our house. Sure the insurance industry should have paid for fixing our house and not taxpayers, but that's another issue. The government officials at FMAP still think we make $240,000 by the way, so this legislation has them record our income accurately. I would add that Republican elected officials in Louisiana support the "FMAP fix" as it's called, but they've sadly let Landrieu take the talk-show heat as they watch from the sideline.
The Nebraska deal for Ben Nelson, tritely labeled the "Cornhusker Kickback," is a horse of a different color. This would have covered in perpetuity the state share of expanded Medicaid coverage. I don't think Senator Nelson was a prostitute. Instead, I think he was doing what he was elected to do, to look out for his constituents. But he could have done that by simply expanding their access to health care coverage, and he probably shouldn't have used his vote for such dramatic leverage. But heck, I would even favor the federal government covering all of the increased state costs for expanding health care. State budgets are starving to death, and I'm sad to see eduction and healthcare bear the brunt.
Got it? Louisiana, a one time fix to accurately record our income after the federal flood and two hurricanes. Nebraska, an ongoing payment to cover the increased state costs for an expanded Medicaid.