Posted on | January 31, 2017 | No Comments
If Tom Price and the Republican Congress plan to roll over health care, they are in for a fight. That is becoming increasingly clear. The latest messenger was the powerful AARP – not commenting (yet) on Medicare, but rather putting out opposition markers to the idea of Medicaid block grants.
The complete AARP statement is available HERE. Their salient point: “AARP opposes Medicaid block grants and per capita caps because we are concerned that such proposals will endanger the health, safety, and care of millions of individuals who depend on the essential services provided through Medicaid.”
Last month, the Commonwealth Fund released a study on Medicaid as well. In their summary they said:
“Medicaid plays a unique role in our health system, acting not only as insurance but as the nation’s most important health care financing safety net. Repeal legislation could eliminate coverage for poor adults who do not meet the program’s traditional eligibility standards while rolling back to pre-ACA levels the financial eligibility standards for parents of minor children, which hovered around 50 percent of the federal poverty level in many states. Furthermore, Medicaid repeal could eliminate coverage of former foster care children, roll back improvements in long-term services and supports, and end the federal funding essential to streamline enrollment for tens of millions of children and adults.
A legislative repeal effort could be accompanied by an aggressive strategy to redesign Medicaid through Section 1115 demonstrations, which could in some respects have even more far-reaching consequences. Aggressive use of such powers that goes beyond the limits of the law could trigger judicial challenges, but such litigation is difficult to mount, and its outcome cannot be predicted. If the Administration uses its Section 1115 powers to tighten eligibility criteria and reconfigure Medicaid along the lines of private insurance, these changes would have enormous consequences.
Since its enactment, Medicaid has been exempt from the types of market constraints essential to a private insurance market, such as enrollment only at specified time periods. Because of Medicaid’s safety-net mission, those who qualify can enroll when they need care. Medicaid also has placed strict limits on patient cost-sharing, precisely because beneficiaries are, by definition, impoverished and highly vulnerable to financial barriers to care. Were legislative repeal of the ACA reforms coupled with demonstrations that tighten eligibility and impose the private insurance model on Medicaid, the effects would be far-reaching, not only for millions who need coverage, but on the health care system itself, which depends on the program to finance health care for the nation’s poorest and most vulnerable children and adults.”