The Medicaid status quo is not effectively serving the health care needs of the disabled, elderly, children, and pregnant women in poverty. Policymakers should ignore hyperbolic political rhetoric claiming that conscientious reforms to secure and improve the safety net for Medicaid’s core populations and to provide better options for coverage and care to others will result in a situation in which “thousands will die.” Obamacare expanded the poorly performing Medicaid and claimed success for doing so. These new recipients can fare better under a new system that broadens their access to quality care. A Medicaid premium support program can accomplish that worthy end.
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Twenty-three years ago, President Bill Clinton and Senate Democrats canceled two weeks of the August recess to pass a major health care bill. They got nowhere.

Now Senate Majority Leader Mitch McConnell is trying the same thing with the GOP for the August break, and it may lead to the same result.

“I’m hoping for better this time,” said Sen. Chuck Grassley (R-Iowa) on Tuesday afternoon after saying earlier he was “very pessimistic” the GOP would succeed. In 1994, Democrats “kept us in and we didn’t accomplish anything.”

. . .

We are 2 former Administrators of the Medicare and Medicaid programs, under Presidents Barack Obama and George H. W. Bush. Although we represent different political parties, we take pride in the accomplishments of these 2 programs, which collectively help millions of US residents get the health care they need.

Medicaid has become a major focus in the debate over repealing the Affordable Care Act (ACA), because the proposed replacement bills go beyond the ACA into the underlying Medicaid program that was originally passed by Congress in 1965. As we have overseen the Medicaid program at various stages, we are familiar with its successes, its areas for improvement, its effect on state budgets, and its importance to millions of ordinary people who count on the program and will need it in the future.

. . .

In the 1990s, there was plenty of teeth-gnashing by welfare reform opponents over changing the funding structure for cash assistance, implementing work requirements, and creating time limits – rhetoric that sounds eerily similar to much of the health reform coverage today.

Mostly absent from the welfare discussion was the role that earned income tax credits (EITC) would play in reform. Similarly, in the current health care debates over Medicaid changes there is a lack of any reference to proposed tax credits.

. . .

The Senate Republicans’ Better Care Reconciliation Act of 2017 (BCRA) would partially repeal and replace Obamacare and make major changes in the Medicaid program. The bill would secure a significant federal entitlement reform by addressing a central health policy issue: the structure, function, and financing of the Medicaid program. It would achieve three major policy goals: reform the entitlement, redirect Medicaid funding to the poorest and most vulnerable members of society, and provide greater authority and flexibility to state officials to manage their own Medicaid programs.
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  • 56% say Medicaid should target set spending to the disabled, elderly, children, and pregnant women in poverty based on their specific needs.
  • 62% say it is a bad thing that Medicaid expansion spends money on childless adults, rather than the most vulnerable populations the program was designed to serve.
  • 57% say it is a bad thing that Obamacare gave states higher reimbursements for adding able-bodied adults to Medicaid than for serving the elderly and disabled.
  • No majority support for any single approach to reform
  • 44% want to keep ACA but make significant changes
  • Slight majority of Americans (53%) approve of the ACA

“The Senate Republican health care bill, the Better Care Reconciliation Act of 2017, is on thin ice, with about ten Republican Senators expressing reservations about the bill. Can Mitch McConnell get 50 senators to yes? What are the implications for the future of health care in America if he can—or can’t?

To help answer these questions, we’re fortunate to be joined by Grace-Marie Turner, the most influential health care scholar in the conservative movement.”

. . .

Sioux Falls Specialty Hospital in South Dakota is regularly full. Its doctors and nurses often have to work longer hours or perform elective surgeries such as hip or knee replacements on weekends.

“In many cases, patients have to wait forever,” said Dr. R. Blake Curd, an orthopedic surgeon and the hospital’s CEO. “We don’t have the physical capacity to take care of them.”

He would like to expand the hospital by adding beds or rooms, but he isn’t allowed to do so because of the Affordable Care Act, or Obamacare. The law largely bans the expansion of hospitals such as Curd’s, which are partly owned by doctors. New physician-owned hospitals also cannot be set up unless they forego government reimbursement from Medicare or Medicaid.

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