As the healthcare debate heats up and despite recent losses, the Republicans prepare to regroup and present another set of plans to repeal and replace the Affordable Care Act (ACA) – also known as Obamacare. One of the biggest challenges will be numerous citizens fighting for precious Medicaid dollars. Whereas the ACA pretty much ensured that Medicaid was a guaranteed benefit for those who needed it, one of the major Republican-backed principles of any repeal plan is likely to provide Medicaid dollars to states as a block grant.
State’s Rights and Flexibility
The Republican ideology argues that states know their needs better than Washington does, and the block grant would give states flexibility in meeting those needs. States would get a fixed amount of money from the federal government, and could make their own decisions on how to spend it.
A Volatile Demand
However, while this intent seems generous, it could limit dollars for the groups who have little to no expendable income – most notably, the children and the elderly. Critics such as NPR’s Ina Jaffe, fear this could do away with many protections that federal law currently provides for vulnerable older people. They also worry about what might happen in an economic downturn, when the demand for Medicaid goes up, but the amount of federal money allocated for it stays the same. For example, would states have to choose between cutting services for poor children versus cutting programs for the frail elderly?
The concern amongst many elder health care advocates is that in the event of a significant funding shortage, politicians (and the general public) are going to be more apt to provide funding for children – and possibly by default, their mothers – thus leaving the elderly (especially the elderly poor) without adequate funding for care.
More Accurate Reporting Requirements
One major change is that, according to The ACA Compliance Bulletin, a Republican-based plan would also modernize Medicaid’s data and reporting systems, repeal the ACA’s disproportionate share hospital (DSH) cuts and make changes to the process for eligibility determinations.