The Senate proposal wouldn’t cut Medicaid spending in real dollars — spending would continue to grow — but it would slow the rate of spending for the program, phase out extra money the federal government has given to states that expanded Medicaid under the Affordable Care Act (also known as Obamacare) and leave states to pick up more of the tab.

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Much of the public discussion about health care and health insurance reform abounds with misinformation. Medicaid, in particular, has become a political tool, with daily posts and articles about reforms to the program that distort the record for political gain. But there is little mention of the need to empower governors to take ownership of the program.

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Section 1332 of the ACA permits states to submit simultaneous and combined “superwaivers” for Medicaid and for provisions of the ACA itself. These superwaivers could make it easier for states proposing plausible ways to allow states that serve Medicaid beneficiaries more efficiently to reprogram federal and state savings into health programs for non-Medicaid eligible households. For households with working, nondisabled adults, it should also be made easier for states to pool their federal and state funds for Medicaid, the Children’s Health Insurance Program (CHIP), the ACA, and other programs to deliver coverage through private plans in the ACA exchanges. It is also time to allow states more flexibility in using Medicaid and other health care funds to invest in the social determinants of health—items such as adequate housing, school-based social services, improved lifestyles, and safer household environments, which can contribute to improved health and reduced medical costs.

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Reforming Medicaid does not have to be an all-or-nothing approach, where millions of people are thrown off of the program to reduce the budget. The states, which administer Medicaid, are closest to the problem and also are in the best position to develop solutions for Medicaid. With leeway to innovate and the pressure to achieve savings, the circumstances are ideal for change.

Since the program’s inception, the federal government has had regulations in place that mandate certain services be provided and that also set rules around eligibility. Those states seeking to innovate have had to secure a waiver from those rules.

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California’s state Senate recently passed a single-payer health-care bill, and we’re warming to the idea as an instructive experiment in progressive government. If Democrats believe the lesson of ObamaCare is that the government should have even more control over health care, then why not show how it would work in the liberal paradise?

The legislation guarantees free government-run health care for California’s 39 million residents—no co-pays, deductibles or insurance premiums—as well as virtually unlimited benefits.

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As Congress works to repeal President Barack Obama’s signature health law, Kentucky Republican Gov. Matt Bevin is already at work unwinding some of its provisions in his state.

Mr. Bevin has dismantled the state’s health-insurance exchange, moving patients to the federal website last year. He has proposed introducing new conditions for recipients of Medicaid, the federal-state health program for the poor, that would require patients to pay premiums of up to $15 a month and perform employment-related or community-service activities, among other provisions

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Blue Cross and Blue Shield of Kansas City announced yesterday it has decided to exit the Obamacare exchange next year. The decision affects about 67,000 Blue KC customers in 30 counties in western Missouri as well as Wyandotte and Johnson counties in Kansas. Danette Wilson, Blue KC’s president and CEO, said that the company has lost more than $100 million total on its exchange plans since the ACA rolled out in 2014.

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The Department of Health and Human Services on Tuesday released a checklist for states that choose to seek waivers from certain Obamacare requirements.

Through the waivers, commonly known as “innovation waivers” or 1332 waivers, states can ask the federal government to allow them to set up high-risk pools, reinsurance programs or another proposal that would reduce costs for customers or allow for more people to be covered.

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Republicans finally hit a home run with a 217-213 vote Thursday to pass a health care bill that will help millions of struggling Americans. They proved they can govern. Yet one of Republicans’ most notable successes is so far getting too little recognition. GOP negotiators embraced the only model that can ultimately see this bill successfully to President Trump’s desk: states’ rights. The compromise is far from perfect—concocted, as it was, under pressure, and with dozens of competing interests in the room. The Senate offers Republicans an opportunity to do much better by building on the idea’s model of states’ rights.
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The MacArthur amendment focuses on an idea that’s core to Republicans’ DNA: federalism.  That’s a positive step forward.  But what still seems to be lacking is a strategic roadmap for what Congress and the Administration should be trying to achieve.  By laying out this roadmap, the Administration can bridge the gap between Republican moderates and conservatives, and possibly open up a much-needed dialogue with centrist Democrats.

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