Major Changes for Medicaid Coming Under Trump, GOP – KTLA
Donald Trump likely won’t let Medicaid collapse, but he will vastly change the health insurance program for low-income Americans.
Think less federal funding, more state control, fewer participants and higher costs for those in the program.
Here’s how Medicaid works now:
Nearly 73 million Americans are on Medicaid or the related Children’s Health Insurance Program (CHIP). The programs cost $509 billion in fiscal 2015, with the federal government shouldering 62% of the bill and states paying 38%.
Most enrollees are low-income children, pregnant women, parents, the disabled and the elderly. Under Obamacare, low-income adults with incomes of up to 138% of the poverty line — $16,400 for a single person — were allowed to sign up in states that opted to expand their Medicaid programs. So far, 31 states, plus the District of Columbia, have done so, adding about 15.7 million more people to the rolls since late 2013, just before the provision took effect. (This figure includes both those newly eligible under expansion and those who always met the criteria.)
While Democrats say the program is a vital part of the safety net, Republicans have long criticized it as being bloated, inefficient and rife with fraud. They want to limit the federal government’s financial responsibility, while giving states more direct control over whom to enroll and what kind of coverage participants receive.
On the campaign trail, Trump was emphatic about having the government provide coverage to the poor, even as he vowed to dismantle Obamacare.
“You cannot let people die on the street, ok?,” he said at a CNN town hall in February. “The problem is that everybody thinks that you people, as Republicans, hate the concept of taking care of people that are really, really sick and are gonna die. We gotta take care of people that can’t take care of themselves.”
But he also championed turning much of the program over to the states. Instead of funding the program through a federal match based on enrollment, Trump would give states a fixed amount of money, known as a block grant, and let them administer it. His presidential transition platform calls for maximizing state flexibility, enabling them “to experiment with innovative methods to deliver healthcare to our low-income citizens.”
Capping federal funding is also popular among Republicans on Capitol Hill. House Speaker Paul Ryan would let states choose whether they want to receive a block grant or what’s known as a per-capita allotment, which would provide a fixed sum based on enrollment. He would also slow the annual rate of growth of funding.
Placing limits on federal reimbursements would end states’ incentive to get more money from Washington by enrolling more residents, and it would prompt states to make their programs more cost-effective, said Brian Blase, a senior research fellow at the Mercatus Center, a libertarian-leaning think tank based out of George Mason University.
“They can come up with different ways to cover vulnerable in their states,” he said.
Left-leaning groups, however, say that funding caps could severely weaken Medicaid. Block grants wouldn’t allow the program to expand during economic downturns. Medicaid enrollment soared during the Great Recession and its aftermath, rising from 42.4 million in 2007 to 55 million in 2013. They point to the weakening of the federal welfare program, which was turned into a block grant in 1996. The core grant has been set at a fixed amount of $16.5 billion since 1996 so its real value has fallen a third because of inflation.