From CNN Money:
Republicans have wanted to repeal Obamacare for years — but they’ve wanted to overhaul Medicaid for far longer.
They are now getting their chance.
The health care legislation working its way through Congress would do much more than its stated purpose of repealing and replacing Obamacare. It would make the most far-reaching changes and deepest cuts to Medicaid in the program’s 52-year history.
“Medicaid: Sending it back to the states. Capping its growth rate. We’ve been dreaming of this since I’ve been around, since you and I were drinking at a keg,” House Speaker Paul Ryan said in March at an event hosted by the conservative National Review magazine.
Lawmakers would effectively end Obamacare’s expansion of Medicaid to low-income adults and would dramatically curtail federal support for the overall program, which covers more than 70 million low-income Americans. They would give states more control and flexibility in administering the program, but also require governors and legislators to foot much more of the bill.
President Trump is committed to making sure that no one currently receiving Medicaid “would be affected in any way,” White House Press Secretary Sean Spicer said Friday. The president feels the Senate bill reflects this and “he’s pleased with that,” Spicer added.
It’s hard to see how these changes would have no impact, however.
Medicaid is the nation’s largest single health insurer, covering nearly one-fifth of all Americans. It insures two in five children and the same share of the disabled, as well as three in five nursing home residents. It pays for nearly half of all births and spending on long-term care in the U.S.
Enrollment shot up to 54.5 million people in the decade before the Affordable Care Act was passed, and total spending nearly doubled to $402 billion, in part because of the Great Recession.
Under the Senate plan, the enhanced funding for Medicaid expansion would end by 2024, after which states would receive the same match for low-income adults as they do for other enrollees. This is four years later than the House bill and serves as a concession to moderate Republicans who don’t want to swiftly turn off the federal spigot. Governors such as John Kasich of Ohio and Brian Sandoval of Nevada, as well as senators from expansion states, have defended the program as critical to helping those affected by the opioid epidemic.
But it’s unlikely that most states could afford to continue covering low-income adults at the reduced match rate, so they would likely have to end their expansions.
All these funding changes would have a huge impact on the Medicaid program, experts say. The House bill would reduce spending by $834 billion over 10 years, compared to current law, according to the CBO analysis.
The cuts might be even more dramatic under the Senate bill, though the CBO analysis might not show it since many of the changes would take place near the end of the 10-year budget window that CBO studies.
“States will face intense fiscal pressure to reduce benefits, cut provider rates and keep higher-cost people off Medicaid,” said Jocelyn Guyer, managing director at Manatt.
Ayn Rand would be proud. She wrote:
Morally and economically, the welfare state creates an ever accelerating downward pull.
That was a couple of years before she cashed her Social Security checks.