Vice President for Health Policy
A number of Republican governors are crafting, but haven’t yet agreed on, a health plan that would cap federal funding for Medicaid, leaked documents show. Specifically, the plan would require states to accept a per capita cap or a block grant in place of current federal funding for the Affordable Care Act’s (ACA) Medicaid expansion, and allow states to opt for a per capita cap or block grant for other groups that Medicaid covers, including parents, children, pregnant women, seniors, and people with disabilities. The plan also proposes other damaging changes in Medicaid, such as letting states cap enrollment and deny coverage to eligible individuals.
Like all proposals to convert Medicaid to a per capita cap or block grant, the governors’ plan would put coverage for tens of millions of low-income individuals and families at risk:
That’s why Democratic governors yesterday reiterated their opposition to per capita caps and block grants, writing that “proposals to radically restructure Medicaid with block grants or per capita caps would flood states with new costs. Such plans would severely damage the ability of states to provide quality health care, inhibit innovative cost-control reforms, and devastate communities fighting opioid and substance abuse.” Likewise, the AARP has written, “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.” And Richard Pollack, the American Hospital Association’s President and CEO, commented yesterday, “redesigning Medicaid, such as through block grants or per capita caps, could lead to substantial changes in benefits and payments and limit the availability of care for patients.” That’s consistent with the position of the bipartisan National Governors Association, which clearly stated in January that any federal changes to Medicaid financing should “not shift costs to states.”
But despite its large problems, the Republican governors’ plan also highlights the huge gulf between key Republican governors and Republican congressional leaders on Medicaid. Comparing the governors’ plan with draft House Republican legislation (leaked on Friday) shows that these policy differences would affect tens of millions of people and tens of billions in federal funding – and would be very difficult to bridge. Similar disagreements among Republican governors are reportedly preventing the Republican Governors’ Association from reaching a consensus on Medicaid.
Ohio Governor John Kasich, reportedly a leader in developing the Republican governors’ proposals, has made his views on the House Republican plan clear: “It’s not acceptable,” he said, adding that “I’m not going to sit silent and just allow them to rip that [Medicaid expansion] out.”
While Republican governors appear open to radical, harmful changes to Medicaid’s financing structure, they and congressional Republicans remain far apart on an array of policy decisions that federal policymakers face on Medicaid, including the future of the ACA Medicaid expansion, whether and to what extent major structural changes should apply to states’ entire Medicaid programs, and whether policymakers should cut funding for Medicaid to help pay for tax cuts.