Re­pub­li­cans’ goal of Med­i­caid over­haul may be­come re­al­ity

The Denver Post - - NEWS - By Chris­tina A. Cas­sidy

atlanta» When Pres­i­dent-elect Don­ald Trump takes of­fice in Jan­uary, Re­pub­li­cans will have the op­por­tu­nity to pull off some­thing they have wanted to do for years — over­haul Med­i­caid, the pro­gram that pro­vides health care to tens of mil­lions of lower-in­come and dis­abled Amer­i­cans.

Any changes to the $500 bil­lion-plus pro­gram hold enor­mous con­se­quences not only for re­cip­i­ents but also for the states, which share in the cost.

Trump ini­tially said dur­ing the cam­paign that he would not cut Med­i­caid, but later ex­pressed sup­port for an idea pushed for years by Re­pub­li­cans in Congress — send­ing a fixed amount of money each year to the states in block grants. Back­ers say such a change in the Med­i­caid for­mula is one of the best ways to rein in spend­ing, but crit­ics say cuts would fol­low.

Cur­rently, the fed­eral gov­ern­ment pays an agreed-upon per­cent­age of each state’s Med­i­caid costs, no mat­ter how much they rise in any given year.

Re­pub­li­cans have ar­gued that states have lit­tle in­cen­tive to keep ex­penses un­der con­trol. Both House Speaker Paul Ryan and Trump’s pick for sec­re­tary of health and hu­man ser­vices, Ge­or­gia Rep. Tom Price, want to switch to block grants.

Key ques­tions fac­ing Re­pub­li­cans will be how the fund­ing is struc­tured and how much flex­i­bil­ity will be given to the states.

“It’s ex­cit­ing be­cause you know it’s not go­ing to be the same as it was, and it’s nerve-wrack­ing be­cause you know it’s not go­ing to be the same as it was,” said Terry Eng­land, a GOP state law­maker who chairs the House bud­get com­mit­tee in Ge­or­gia.

Repub­li­can con­trol of Congress and the pres­i­dency means the GOP can act on its long-held pri­or­i­ties of rein­ing in en­ti­tle­ment pro­grams and re­peal­ing the Af­ford­able Care Act, which al­lowed states to ex­pand the num­ber of peo­ple eli­gi­ble for Med­i­caid. Thirty-one states have opted for the ex­pan­sion.

It is not clear what the GOP’s re­place­ment plan will look like. Democrats have warned of dire con­se­quences, and any pro­posed changes are likely to trig­ger a fight in Congress.

More than 70 mil­lion are on Med­i­caid, nearly 10 mil­lion of them cov­ered as a re­sult of the ex­pan­sion.

How the GOP over­haul is ul­ti­mately struc­tured will be crit­i­cal, said Matt Salo, ex­ec­u­tive di­rec­tor of the National As­so­ci­a­tion of Med­i­caid Di­rec­tors.

“Some of my mem­bers are look­ing at this and say­ing if this isn’t done right, if the money doesn’t match what needs to be done, this is po­ten­tially the great­est in­ter­gov­ern­men­tal trans­fer of fi­nan­cial risk in the coun­try’s his­tory,” he said.

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