Congressional Republicans have been struggling for months to resolve one of the most vexing problems in their tortuous effort to replace the Affordable Care Act: What to do about the generous federal funding for states that broadened their Medicaid programs under the law, while not shortchanging the 19 states that balked at expansion?
Now, as the House begins to hone details of its legislative proposal, a possible compromise has emerged. It would temporarily keep federal dollars flowing to cover almost the entire cost of the roughly 11 million Americans who have gained Medicaid coverage but would block that enhanced funding for any new participants.
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America spends too much on Medicaid relative to other programs and services that might have a bigger impact on measured health outcomes for the poor. Giving states more flexibility in reaching these broad population health goals and better tools for measuring their progress would help states and the federal government scale up what works, while phasing out what doesn’t. Seema Verma, Trump’s pick to lead the Centers for Medicare & Medicaid Services, called for CMS “as the nation’s largest purchaser of health care…[to] do more, achieve more than the mere distribution of insurance cards,” saying it should use its programs to “truly make a difference in people’s lives to prevent and cure disease, manage chronic illnesses, and promote healthy lifestyles and independence from government assistance.”
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Let the states derive their own health care solutions, particularly when it comes to cost containment. That’s why we may need to look to six states that are aggressively working to contain costs. The Florida, Georgia, Alabama and Tennessee legislatures are considering a proposal to eliminate defensive medicine by abolishing each state’s medical malpractice system and replace it with a no-blame model similar to workers’ compensation. Two other states are also examining the concept. When doctors are no longer the target of litigation, they would be less likely to order unnecessary tests, medications and procedures.
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House Republicans are weighing specific reforms to Medicaid that could be included in a reconciliation measure to overhaul the Affordable Care Act.
How to deal with the federal expansion of Medicaid under the ACA is one of the main unanswered questions as Congress works to overhaul Obamacare — one that has exposed divisions between the House’s most conservative members and GOP lawmakers from states that chose to expand the federal program for low-income Americans.
Rep. Brett Guthrie (R-Ky.), the vice chairman of the Energy and Commerce Health Subcommittee, said Tuesday that lawmakers are considering what types of reforms — specifically shifting to per capita allotments or allowing states to choose block grants — could be included in a House reconciliation bill to repeal the ACA.
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A Republican proposal to change how Medicaid is financed could save the federal government up to $150 billion, according to a new report. Block-granting Medicaid—when states receive a set amount of federal money to put towards the program—would result in $150 billion less in federal Medicaid spending over five years, according to an analysis released Monday by Avalere Health. Shifting to per capita caps—when states receive a set amount of federal money per beneficiary—would save $110 billion over five years, according to the analysis.
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Senate Democrats have pummeled Rep. Tom Price, President Trump’s pick to lead the Department of Health and Human Services, for supporting Medicaid block grants, but it’s a policy unlikely to win a place in Republicans’ Obamacare repeal-and-replace plan.
If Republicans succeed in making significant changes to Medicaid, they more likely would turn to a more moderate per-capita system embraced by a wider swath of Republicans. Like block grants, a per-capita system would limit federal contributions, but it would allow federal assistance to rise with enrollment growth.
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On the question of what should be done about Medicaid expansion under Obamacare, Republicans should combine two ideas popular in their party: block grants and health savings accounts. The former would let states tailor their Medicaid policies to their local communities, while the latter would give enrollees the ability to choose their own insurers and providers. In essence, Washington could give the states Medicaid block grants, allocated per capita, to provide beneficiaries with high-deductible insurance and health savings accounts.
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House Republicans on Wednesday highlighted changes to Medicaid in a series of bills that target eligibility, but got stiff pushback from Democrats who argue the GOP actually wants to cut federal aid to low-income Americans.
A subcommittee of the House Energy and Commerce Committee examined three draft bills that would prevent lottery winners and illegal immigrants from getting Medicaid coverage. Another bill would close a loophole that allows couples to get Medicaid although their income and assets are beyond the threshold for eligibility.
Republicans argued the bills, introduced in earlier Congresses, are needed to reform an entitlement program that has used more and more federal funding.
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Since its passage in 1965, Medicaid has expanded and contracted with the political tides. With concurrent Republican executive and legislative control in 2017, conservative policy makers have already declared their desire to repeal the Affordable Care Act (ACA) and its Medicaid expansion, which has been responsible for approximately 12 million of the 20 million individuals who became newly insured as a result of the ACA. But proposals for fundamental reform of Medicaid are even more far-reaching in terms of their consequences for the other 60 million low-income children, parents, the elderly, and individuals with disabilities who rely on the program. Understanding the rationale for and likely effects of these proposals is critical for physicians and patients alike.
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Many Obamacare supporters claim the law has expanded health coverage to upwards of 20 million Americans, but new data shows that isn’t accurate.
As part of Congress’ continued push to repeal Obamacare, the House Budget Committee held a hearing this week titled “The Failures of Obamacare: Harmful Effects and Broken Promises.”
Heritage Foundation expert Ed Haislmaier was one of four expert witnesses who testified.
Haislmaier presented new data regarding gains in health coverage since the full implementation of Obamacare began in 2014.
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