ADevilYouKhow
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Senate GOP Shoots Down Proposed Protection for Maternity Coverage, Free Contraception
Another boon for taxpayers
Another boon for taxpayers
115th Congress defunds ACA: Senate: 51-48 House:227-198; Executive Order signed 1/20
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State Flexibility: A Trojan Horse for Weakening Medicaid
Second, the Congressional majority hopes to realize its longtime dream of changing Medicaid’s financing structure to a block grant. Instead of the current system of the federal government matching a certain share of state Medicaid payments, under this approach states would receive capped payments. Since the size of the block grants would grow more slowly than health cost inflation, this would increasingly shift costs onto state budgets over the years, especially during recessions.
Conservatives frame block grants as increasing state flexibility. This is technically true, in the same sense that a worker who gets laid off suddenly has much more flexibility in how they spend their time. Understandably, however, the prospect of being broke generally takes precedence.
That’s why in reality, budgetary concerns tend to be more important to state officials than “flexibility.” And in that respect, block grants represent a massive cut to state budgets over time.
For example, Louisiana Secretary of Health Rebekah Gee has sharply criticized block grant proposals for Medicaid, explaining that, “In a block grant scenario it would be a rationing – we'd have to ration care and who do we provide care to . . . when they talk about flexibility, it's flexibility to cut services. We have tremendous flexibility now. We do not need more flexibility.”
Secretary Gee isn’t bluffing about the stark math that states would face under block grants. Estimates have shown that by the tenth year of block grants, federal Medicaid funding would have been cut by one-third compared to current law, with 14 to 20 million people losing coverage. Although Speaker Ryan recently proposed giving states a choice between block grants and per capita caps, this is not a compromise. Per capita caps would be calculated as a capped amount per person rather than per state, but would still massively cut Medicaid funding.
Third, key members of the incoming administration hope to aggressively transform Medicaid’s benefits, eligibility, and cost-sharing through administrative actions and waivers – undermining the program without needing Congress’s help. Over the past few years, we’ve seen a limited preview of this in some states that have used waivers from the federal government to take more conservative approaches to expanding Medicaid, often focused around increased cost-sharing and health savings accounts. For example, Indiana requires Medicaid expansion enrollees to pay premiums to receive the full benefits plan; those below the poverty level who don’t pay are shifted to a more limited plan, while those above the poverty level who don’t pay are dropped from coverage and banned from re-enrolling for six months.
Yet while the Obama administration has compromised with several governors on these more conservative arrangements in order to encourage them to expand Medicaid, it has held the line against more harmful waiver proposals that would undermine the objectives of the Medicaid program. Most notably, it has consistently rejected proposals to add work requirements to Medicaid.
Regardless of Trump’s campaign rhetoric on Medicaid, since the election he has nominated Seema Verma, the architect of waiver proposals in Indiana and Kentucky, to lead the Centers for Medicare and Medicaid Services. Under her leadership, CMS is likely to not only approve but encourage more harmful proposals. The policy changes the Trump administration could pursue include work requirements, premiums and higher cost-sharing for low-income enrollees, dis-enrollment with a six-month lockout for beneficiaries who fail to pay premiums or meet other requirements, more limited benefit packages, and overall caps on Medicaid enrollment.
State Flexibility: A Trojan Horse for Weakening Medicaid | RealClearHealth
Second, the Congressional majority hopes to realize its longtime dream of changing Medicaid’s financing structure to a block grant. Instead of the current system of the federal government matching a certain share of state Medicaid payments, under this approach states would receive capped payments. Since the size of the block grants would grow more slowly than health cost inflation, this would increasingly shift costs onto state budgets over the years, especially during recessions.
Conservatives frame block grants as increasing state flexibility. This is technically true, in the same sense that a worker who gets laid off suddenly has much more flexibility in how they spend their time. Understandably, however, the prospect of being broke generally takes precedence.
That’s why in reality, budgetary concerns tend to be more important to state officials than “flexibility.” And in that respect, block grants represent a massive cut to state budgets over time.
For example, Louisiana Secretary of Health Rebekah Gee has sharply criticized block grant proposals for Medicaid, explaining that, “In a block grant scenario it would be a rationing – we'd have to ration care and who do we provide care to . . . when they talk about flexibility, it's flexibility to cut services. We have tremendous flexibility now. We do not need more flexibility.”
Secretary Gee isn’t bluffing about the stark math that states would face under block grants. Estimates have shown that by the tenth year of block grants, federal Medicaid funding would have been cut by one-third compared to current law, with 14 to 20 million people losing coverage. Although Speaker Ryan recently proposed giving states a choice between block grants and per capita caps, this is not a compromise. Per capita caps would be calculated as a capped amount per person rather than per state, but would still massively cut Medicaid funding.
Third, key members of the incoming administration hope to aggressively transform Medicaid’s benefits, eligibility, and cost-sharing through administrative actions and waivers – undermining the program without needing Congress’s help. Over the past few years, we’ve seen a limited preview of this in some states that have used waivers from the federal government to take more conservative approaches to expanding Medicaid, often focused around increased cost-sharing and health savings accounts. For example, Indiana requires Medicaid expansion enrollees to pay premiums to receive the full benefits plan; those below the poverty level who don’t pay are shifted to a more limited plan, while those above the poverty level who don’t pay are dropped from coverage and banned from re-enrolling for six months.
Yet while the Obama administration has compromised with several governors on these more conservative arrangements in order to encourage them to expand Medicaid, it has held the line against more harmful waiver proposals that would undermine the objectives of the Medicaid program. Most notably, it has consistently rejected proposals to add work requirements to Medicaid.
Regardless of Trump’s campaign rhetoric on Medicaid, since the election he has nominated Seema Verma, the architect of waiver proposals in Indiana and Kentucky, to lead the Centers for Medicare and Medicaid Services. Under her leadership, CMS is likely to not only approve but encourage more harmful proposals. The policy changes the Trump administration could pursue include work requirements, premiums and higher cost-sharing for low-income enrollees, dis-enrollment with a six-month lockout for beneficiaries who fail to pay premiums or meet other requirements, more limited benefit packages, and overall caps on Medicaid enrollment.
State Flexibility: A Trojan Horse for Weakening Medicaid | RealClearHealth
ADevilYouKhow
Rhyme Reason
@tru_m.a.c this is really serious from a health care and economic/ notional/state debt point of view.
Are you worried?
Are you worried?
this.
in states like texas that rejected medicaid expansion, you can't make more than $3-4k in a year in order to qualify.
Berniewood Hogan
IT'S BERNIE SANDERS WITH A STEEL CHAIR!
The party of Christian values seems to think Jesus wouldn't heal lepers or the blind because of their pre-existing conditions.
Foxmulder
Superstar
One good thing about this shyt is people are going to see what the republicans are all about. When they fukk everything up again just like the Bush years they got no one to blame.
Democrats could just be
we told y'all.
Democrats could just be we told y'all.
My mother is a doctor worked in one of these red state Midwestern towns fill of opioid and heroin addicts, former coal miners, and morbidly obese Walmart shoppers. She has since left, thank god.
The hospitals there are freaking out over the repeal of ACA because of provisions in ACA that kept them afloat.
Once this shyt goes away, these rural hospitals will be hit the hardest because they rely on ACA provisions more than anyone else to keep their doors open. So many rural hospitals will be closing their doors and these people will be more out of luck.
I'm still enjoying the schadenfreude of the whole thing.
The hospitals there are freaking out over the repeal of ACA because of provisions in ACA that kept them afloat.
Once this shyt goes away, these rural hospitals will be hit the hardest because they rely on ACA provisions more than anyone else to keep their doors open. So many rural hospitals will be closing their doors and these people will be more out of luck.
I'm still enjoying the schadenfreude of the whole thing.
I still believe this is going to be political suicide for Republicans. I really think they are going to lose seats during the mid-term elections in a couple years. Depending on how bad this gets, they might lose majority in the senate. Not sure about the House since they have a larger majority there.
88m3
Fast Money & Foreign Objects
My mother is a doctor worked in one of these red state Midwestern towns fill of opioid and heroin addicts, former coal miners, and morbidly obese Walmart shoppers. She has since left, thank god.
The hospitals there are freaking out over the repeal of ACA because of provisions in ACA that kept them afloat.
Once this shyt goes away, these rural hospitals will be hit the hardest because they rely on ACA provisions more than anyone else to keep their doors open. So many rural hospitals will be closing their doors and these people will be more out of luck.
I'm still enjoying the schadenfreude of the whole thing.
I've been saying this to people for years. How do people not understand this!
Berniewood Hogan
IT'S BERNIE SANDERS WITH A STEEL CHAIR!
"Fake news."
It won't be breh
The Koch network and all the big $$$ there is going to keep the House for them
The GOP has gerry mandered and stacked the deck
88m3
Fast Money & Foreign Objects
I just can't...
Jesus H. Christ
I died for your sins
TrumpCare y'all
this.
in states like texas that rejected medicaid expansion, you can't make more than $3-4k in a year in order to qualify.
Just in case you thought he was lying....
And medicaid is only extended to adult with children or adults with disabilities.....
Maximum monthly income limits
Family size One Parent Two Parent
1 $152 --------
2 $262 $227
3 $313 $334
4 $376 $384
5 $426 $448
Each additional person, add: $69 $69
Health Care | How to Get Help
I'm tired.
I have no hope for this country tbh. My personal values keep me pushing.