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The Medicaid program was established as a federal-state partnership, but it has become a partnership in name only as the result of a complicated maneuver in which states impose taxes on health care providers in order to extract tens of billions of dollars yearly from the U.S. Treasury via an arcane Medicaid financing mechanism. The scheme renders Medicaid almost entirely a federally financed — or over-financed — program.

Almost every state employs this tax maneuver to
trigger the annual release of matching funds over and above the money the
federal government sends as its share of reimbursements to hospitals for
medical services they provide to Medicaid patients. In a 2014
report, the General Accountability Office
criticized these so-called provider taxes, which fall most heavily upon
hospitals.

One might wonder why the government is taxing
hospitals, which raises the cost of the nation’s primary providers of health
care services. Many are nonprofit organizations; why tax nonprofits? Many are
for-profit organizations and already pay corporate income taxes; why levy a
second tax? It is truly strange and wonderful.

Take Connecticut, for example.

Michael Bloomberg’s entry into the presidential race about a week ago was panned almost universally. Political pundits dismissed his bid, many with trite “truisms” about political tradecraft. First, that money can’t buy the presidency. Second, that his late entry is fatal. Third, that by skipping the first four contests, he will fall hopelessly behind. Fourth, his policy stands are all over the map, so he has no natural following or base.

But maybe Bloomberg has a strategy. After all, if he’s so dumb, why’s he so rich? Let’s hazard some thoughts on possible strategy. Maybe Bloomberg is crazy like a fox.

First, let’s be realistic, his $50 billion provides him a tremendous advantage.

Second, pundits have deemed his late entry to be fatal, as if late entry alone were as fatal as stage four pancreatic cancer. What has passed as analysis has been limited to references to the failure of other late entrants. Yet, none of the referenced candidates had Bloomberg’s money, and virtually all failed for reasons other than late entry — and the same reasons have felled early entrants.

In 2016, late entrant Rick Perry was felled by momentary brain freeze about the third in his trademark list of three federal agencies he’d shutter. However, the earliest entrant in the 1968 contest, George Romney, was eliminated well into his campaign by just one word, “brainwashed,” and in 1972 another early contender, Ed Muskie, by a single sob on the campaign trail just days before the New Hampshire primary.

Third, skipping the first four contests has an obvious and compelling rationale. To flip a popular saying: You can’t lose it if you’re not in it. This is a variant of the successful strategy of American revolutionaries: They ran away to fight another day. Bloomberg will survive the first four contests. Every other candidate, except four at most, won’t.

There are virtually no delegates at stake in these early contests — just 4 percent of the total. The winner(s) of those contests will have virtually nothing to show for the enormous effort entailed, except bragging rights, which then must be defended in the next of the four contests to meet elevated expectations and to maintain momentum.

Bloomberg won’t have lost any meaningful ground, unless one candidate rolls the table, winning all four early contests. What are the odds of that? South Bend, Ind., Mayor Pete Buttigieg has surged into the lead in Iowa and New Hampshire, but is mired in single digits in the following contest in South Carolina, where former vice president Joe Biden holds a commanding 19-point lead.

If Bloomberg hasn’t lost anything, what has he gained by skipping the first four contests? Here it gets interesting.

House Speaker Nancy Pelosi (D-Calif.) has suggested delaying or scrapping the annual State of the Union address by the president of the United States to a joint session of Congress and that, instead of delivering the address in person, President Trump send a written report. Pelosi alleges security concerns and hasn’t filed a concurrent resolution to set Jan. 29 as the day for his speech.

Let’s call this The Pelosi Shutdown, or The Pelosi Snub, or The Pelosi Snub-down.

No matter how ludicrous Pelosi’s pretext… er, reason, Trump should agree immediately, and then, Senate Majority Leader Mitch McConnell (R-Ky.) should step in with an invitation for Trump to deliver an address in the Senate chamber.

Red Jahncke

Red Jahncke is a nationally recognized columnist, who writes about politics and policy. His columns appear in numerous national publications, such as The Wall Street Journal, Bloomberg, USA Today, The Hill, Issues & Insights and National Review as well as many Connecticut newspapers.