There Was No Nebraska Compromise

I am going to put this out there.

There was a lot of hoopla about a thing called the "Nebraska Compromise".

What basically happened is Nebraska Senator Ben Nelson got the federal government to pick up a 100% portion of Medicaid to vote on the health care bill.

Some are calling it unconstitutional, some are accusing Senator Nelson of selling the other states down the proverbial river.

I am calling it legitimate.  Here is why:

If one takes the time to look at the concept of "pilot programs"  one would see why they are called "pilot".  A pilot program is when a program is launched in specific geographic regions, monitored and then evaluated for full implementation and absolute diffusion.

What we have is Nebraska being one of the regions being selected to pilot 100% funding coverage the entire state's Medicaid program.  There are other states also selected to receive Medicaid increases in federal funding portions.

What we have here, ladies and gentlemen, is your classic program evaluation research.

Now, let us examine the sampling methodologies.

States that seem to have adopted the agenda to certify electronic health records and maintain electronic databases seem to be the ones who were selected to be treated with the increased FFPs. When a state is data-rich, then highly reliable evaluations may be executed, replicated and generalized to produce the most beneficial programs and policies, in compliance with the provisions of the Sarbanes-Oxley Act of 2002 and the Federal Financial Management Improvement Act of 1996, the tools for audits.

OMB Memorandum on Federal Financial Portion of Medicaid


Nebraska has one of the broadest coverage of data, being inclusive of all Medicaid operations.

Massachusetts is research-orientated focusing on information accessibility.

Vermont has established a public Health IT Fund to monitor procurement and purchasing, and to fund progressive home medical project.

Louisiana has adopted an aggressive campaign to end Medicaid and Medicare fraud.

Now, we have Attorneys General of Michigan, South Carolina, Washington, Texas, Colorado, North Dakota, Alabama, Virginia, Pennsylvania, Utah, Florida, Idaho, and North Dakota throwing constitutional temper tantrums. This is not the first time these states have fallen to the floor in public, snotty screaming, that it would be impossible to be compliant in the areas of Medicaid funding.

It needs to be noted that the States Attorney General are in charge of its Medicaid Fraud Control Unit. The aforementioned state Units are extremely weak and breathtakingly ineffective.

Well, if these states were not the worst when it comes to Medicaid fraud, mainly in child welfare, they would have had a viable chance to get into this evaluation pool. Nebraska is trying to clean up its act, and so can the rest of the States.

CMS Guidance to Electronic Health Records

Senator Ben Nelson and all the other Senators, congratulations for standing strong on the battlefront to end Medicaid fraud in child welfare, Medicaid and Medicare fraud, and all other forms of health care fraud, waste and abuse.