Governor appeals to President Obama to preserve Medicaid safety net


Gov. Togiola Tulafono has written to U.S. President Barack Obama for his assistance in the “preservation of the Medicaid safety net in American Samoa.”

In his May 24 letter, the governor noted that in 2010 the U.S. Congress enacted the Affordable Care Act and in this law, Medicaid assistance for the needy was strengthened in several ways.

“For the territories, the law increased Medicaid funding so that people already under this safety net, would receive essential medical care,” the governor wrote. “Specifically, section 2005 of the law increased the federal funding cap and match rate for the territories.”

He noted that states and territories have a Federal Medicaid Assistance Percentage based on respective poverty rates— per capital personal income of the people in relation to nationwide per capita personal income.

The percentage, which is set annually, determines the federal matching funds for state and territory expenditures for medical assistance, he said, but the federal match for the territories, unlike the states, had been limited to a fixed dollar amount.

Additionally, the federal match rate for the territories had been capped at 50%. “In contrast, the federal match rate for states could reach 85%. States have received enhanced federal matching under this formula of 70% and 80%,” he said.

According to the governor, the 2010 law did not remove the percentage cap or the fixed dollar limit for the territories.

“To partly correct the discrepant treatment of people in the territories, however, the law raised the percentage cap to 55% and increased the fixed dollar limit by 30%,” he wrote.

“American Samoa welcomed these partial legislative corrections. The additional funds secured health services for low-income children, pregnant mothers, elderly, disabled, and parents of dependent children,” he said. “The funding provided more care, greater access, and higher provider payments.”

However, on May 10 this year, the U.S. House passed the Sequester Replacement Act of 2012—H.R. 5652— and this bill implemented the Budget Resolution for FY 2013, which the U.S. House had earlier adopted on Apr. 29, he said.

According to the governor, Section 214 of the implementing bill would repeal the 30% increase in the federal Medicaid dollar cap as well as the 5% increase in federal match rate for the territories.

He also informed Obama that the 17 health care groups comprising the Partnership for Medicaid in an Apr. 24, 2012 open letter to Congressional leadership explained the bill’s effect on Medicaid. The letter specifically states that repeal of funding for the territories “would impede access to care.”

The governor said the U.S. Senate on May 16 voted against the proposal.

“The 2010 legislation did not remove the funding disparity between the territories and states. The Affordable Care Act only lessened the disparity,” the governor explained. “The proposed repeal of that small step, however, will reduce health care for people in the territory who can least afford it.”

“In the ongoing congressional budget negotiations with Congress, I hope and ask that you will preserve the health care improvements that have brought needed health care to people in American Samoa,” he said and asked Obama for his “favorable consideration” of American Samoa’s request.

Copies of the letter were sent to Congressman Faleomavaega Eni, the Fono leadership and David Agnew, Director of Intergovernmental Affairs at the White House.


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