Republicans’ goal of Medicaid overhaul may become reality

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.