WHILE THE US IS REELING FROM COVID-19, THE TRUMP ADMINISTRATION IS TRYING TO TAKE AWAY HEALTH CARE
WHILE THE US IS REELING FROM COVID-19, THE TRUMP ADMINISTRATION IS TRYING TO TAKE AWAY HEALTH CARE
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program for low-income Americans that also covers many disabled and elderly people. WHILE THE US IS REELING FROM COVID-19, THE TRUMP ADMINISTRATION IS TRYING TO TAKE AWAY HEALTH CARE
The Conversation logo While the US is reeling from COVID-19, the Trump administration is trying to take away health care
The death toll from COVID-19 keeps rising, creating grief, fear, loss and confusion.
a man and a woman holding a cake: People affected by the downturn in the economy caused by coronavirus at a food bank in Central Florida in April, 2020. © Paul Hennessy/NurPhoto/Getty Images People affected by the downturn in the economy caused by coronavirus at a food bank in Central Florida in April, 2020.
Unfortunately for us all, the pain only begins there. Other important health policy news that would ordinarily make headlines is buried under the crushing weight of the coronavirus. Many have not had time to notice or understand the Trump administration’s efforts to wreck health care coverage.
We are both professors at Boston University School of Public Health who study health insurance, one using economics and statistics and the other focusing on law and policy. We have researched the big picture of COVID-19’s impact on the safety net and the details of how our federalist system, with states having considerable control over policy, has made a coordinated response to the pandemic more difficult.
Here, we highlight two major actions by the Trump administration that should be receiving more attention – attempting to cap federal Medicaid funding, and arguing to the Supreme Court that the entire Affordable Care Act should be struck down.
a group of people on a bed: COVID-19 patients arrive to the Wakefield Campus of the Montefiore Medical Center on April 06, 2020 in the Bronx borough of New York City.© John Moore/Getty Images COVID-19 patients arrive to the Wakefield Campus of the Montefiore Medical Center on April 06, 2020 in the Bronx borough of New York City.
Limits on Medicaid funding
Complicated language and political posturing make it hard to understand health care in the best of times. This is particularly true for proposals to change the funding for Medicaid, the health insurance
Medicaid has historically been funded like this: States pay a percentage of Medicaid costs, and the federal government covers the rest. The federal match ranges from 50% to as much as 83% of every dollar. It doesn’t matter whether a state has one thousand or one million Medicaid enrollees, that same cost sharing applies. Uncapped federal funding gives Medicaid flexibility to meet that need.
The Trump administration wants to change the promise of unlimited federal funding and instead use a payment method often called “block grants.”
Block grants are pre-set amounts of money that the federal government offers to states, which then have control over the money within broad guidelines. While that may sound harmless and even appealing to some, block granting reduces the amount of federal money available and shifts the risk of economic, health, and other emergencies to states. Medicaid block grants would set limits on how much money the federal government spends, either in total or per person.
a man wearing a suit and tie: President Lyndon Johnson, left, shakes hands with former President Harry Truman when Medicare and Medicaid became law in 1965. Truman had tried to pass Medicare-like bill but failed. Vice president Hubert Humphrey is in the background.© LBJ Presidential Library President Lyndon Johnson, left, shakes hands with former President Harry Truman when Medicare and Medicaid became law in 1965. Truman had tried to pass Medicare-like bill but failed. Vice president Hubert Humphrey is in the background.
Medicaid has never been capped this way in its 55-year history, but block granting for Medicaid has long been an unfulfilled dream for conservatives, with Ronald Reagan, Newt Gingrich, and Paul Ryan trying but failing to make block grants a reality.
A work-around
When the GOP-dominated Congress tried in 2017 to repeal the ACA, many replacement bills featured Medicaid block grants. The bills failed in the Senate, with the late Sen. John McCain, R-Arizona, casting a famous deciding vote.
The Trump administration decided to try a different road. In January 2020, the Centers for Medicare and Medicaid Services issued a letter to state Medicaid directors describing a new Healthy Adult Opportunity policy that would fundamentally change the way Medicaid has always worked by implementing block grants.
Instead of the current partnership, in which the pie (Medicaid spending) can expand but the pieces (federal and state share of costs) stay the same size relatively, this new block grant policy would provide states either a set dollar amount for each enrollee (a per capita cap) or for their entire program (a fixed annual grant). Either way, the state would be responsible for any extra costs. To be clear, we and others believe this policy is illegal without a change in federal law.
So why would states pursue this? Political ideology and less federal oversight are