Medicaid Block Grants Are Back

Written by SK Ashby

Dating as far back as former Speaker of House Paul Ryan's time as the chairman of the House Budget committee, Republicans have spent most of the last decade trying and failing to convert the Medicaid health care program into a system of block grants that would set a hard cap on the amount of money that states receive to provide health care for the elderly, poor, and disabled.

We even had an entire election about that issue, as I'm sure you recall, when former GOP presidential candidate Mitt Romney chose Paul Ryan as his vice presidential running mate.

Of course, losing an entire election on the issue didn't deter Congressional Republicans who tried to convert Medicaid into a block grant system as recently as 2017.

Now, since converting the entire national Medicaid program into a block grant system through legislation is clearly never going to work, the Trump regime is taking a different approach by giving states the option of taking a block grant rather than the open-ended coverage they currently enjoy.

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said states that sought the arrangement — an approach often referred to as block grants — would have broad flexibility to design coverage for the affected group under Medicaid, the state-federal health insurance program for the poor that was created more than 50 years ago as part of President Lyndon B. Johnson’s Great Society. [...]

“There’s no question this plan provides unprecedented flexibility to states to restrict health care under Medicaid,” said Larry Levitt, executive vice president for health policy at the nonpartisan Kaiser Family Foundation. “What is less clear is how many states will want to do that and be willing to roll the dice with a cap on federal contributions.

Indeed, the only silver lining here is that states probably aren't going to line up for this.

Conservative, Republican-controlled states could prove us wrong, but there's a significant difference between making the case the Medicaid should be transformed at the national level versus sacrificing your own state and no one else. Taking this option would mean transforming the state program, not the federal program, and that means facing local constituents directly on the matter.

Making changes to Medicaid at the state level while the national program remains unchanged didn't work out very well for former Kentucky Governor Matt Bevin who led the charge to impose all manner of new requirements and red tape on the state's Medicaid program.

I think all but the most ideologically isolated state lawmakers would find this to be a tough sell.