Medicaid block grants

This week on This Week, George Stephanopoulos did a slightly less awful job this week. Not good – but not as bad as usually, pointing out the effect of Medicaid block grants (still using the fig leaf of “President Clinton said,” which is why I won’t say it was good) upon the poor and needy:

STEPHANOPOULOS: President Clinton also took aim at the savings you do propose in Medicaid — $800 billion — the largest specific savings in your plan. That’s about a 35 percent reduction over the next decade.

And the president argued that it’s going to be devastating for seniors who rely on Medicaid for nursing home care, middle class families challenged by disabilities, children with autism. How can you squeeze that much money of a program, $800 billion without cutting benefits or restricting eligibility?

RYAN: Here’s the secret on this one. Medicaid spending still goes up under what we’re proposing. What we’re saying is we want to repeal ObamaCare because we think it’s a terrible law. And so we’re taking away the massive increases in ObamaCare that are attributable to Medicaid. About a third of the people that ObamaCare is supposed to serve, they’re just pushing people on Medicaid.

Here’s the problem, George. Medicaid’s not working. More and more doctors are less likely to even take people with Medicaid. It’s a system that needs reforming.

So we don’t want to put more money and force more people on a program that’s failing, that’s not working. We want to reform Medicaid. And so what we’re saying is, don’t expand this program as dramatically as ObamaCare does. Keep it like it is, increase its funding and send it to the states to the states can fix this problem. I think government closest to the people, especially in providing health care for the poor, works the best.

STEPHANOPOULOS: But The Urban Institute has estimated that between 14 million and 27 million people will — fewer people will be covered under that plan and won’t [that be] block granting this program, sending it to the states mean that low-income and disabled people will lose their guaranteed right to coverage?

RYAN: No, not at all, of course not. Look, governors are asking us all the time for more flexibility on Medicaid. There are a lot of different —

RYAN: — ideas out there on how best to cover the low-income populations of various states. And look, every state has different issues and different problems. So we want to be able to give the states the tools they need, make sure that they spend this money on their Medicaid population, but give them the ability to fix the problems in their unique state —

STEPHANOPOULOS: But doesn’t —

(CROSSTALK)

STEPHANOPOULOS: — individuals will not have a federal —

RYAN: — (inaudible) —

STEPHANOPOULOS: — guarantee under a block grant. That’s correct, isn’t it?

RYAN: Sure. No, it — with maintenance of that — I won’t get into the details, but with maintenance of effort requirements, which is what we’ve done in the past, they still have to serve this population. They just get more flexibility on how to serve this population instead of all these rules and strings from Washington that make it really hard for them to make sure that they can meet the mandate and provide the best possible quality care to low-income populations.

Ah yes, the block grant idea so beloved of conservatives. Now, with increased storms, wildfires, tornados and floods, how do you suppose that would work out in practice?

Surprisingly, Governor Jindal, who is seeking 100 percent federal support from the federal government from the Federal Emergency Management Agency (FEMA) and will be undoubtedly grateful for increased federal Medicaid support in response to Hurricane Isaac, is supporting the idea of a Medicaid block grant. It is surprising because, under a block grant such as that proposed by House Budget Committee Chairman and Vice President Candidate Paul Ryan, Louisiana would be responsible for 100 percent of any increased costs associated with any hurricane or disaster.


Texas Governor Rick Perry, who is also supporting a Medicaid block grant, should know better as he has been governor when Hurricanes Katrina and Rita rocked the State in 2005. Fortunately, for Texas, the federal government stepped in to provide nearly $1 billion in aid to the State of Texas in response to these two hurricanes, including over $500 million in federal Medicaid support. However, under a Medicaid block grant, federal aid would be unresponsive or zero.

Governors, like fish that see the worm, need to open their eyes wider and see the hook. They may be enticed by some vague promise of flexibility, but they need to recognize the harsh reality that a block grant puts into place an arbitrary cap that is merely a tool for the federal government to walk away from its commitment to help our nation’s most vulnerable children, people with disabilities, and senior citizens with medical assistance in times of crisis.

Fortunately, other political leaders from states in the Gulf Region can point the way, as they have long understood the enormous problems associated with Medicaid block grants. For example, when House Speaker Newt Gingrich proposed block granting the Medicaid program in 1995 (17 years ago), Florida Senator Bob Graham (my former boss) cited Hurricane Andrew, which devastated his state in 1992, as one of the many reasons the idea of Medicaid block grants should be rejected. As he said on the Senate floor:

“What do the states relinquish in exchange for the marginal new flexibility that they will allegedly receive? The federal partnership to assist them, if they experience caseload growth will be surrendered.

Senator Graham added:

…when Hurricane Andrew hit South Florida, our Medicaid caseload shot up by 12,000 people. Not only had their homes been blown away, their jobs had been blown away. Therefore, people who had been employed and self-supporting needed the assistance of Medicaid during that time of crisis.

Under block grants, a State that is knocked down to its knees by a flood, earthquake, hurricane, would not find a helping hand from the federal government at the time it needed to get back on its feet. No, Mr. President, acts of God and block grants do not mix.