This morning, Tennessee’s Republican governor announced that the state had submitted a plan to convert their Medicaid program into block grants, all at the behest of the Trump administration. Block granting Medicaid is a blatant attempt to gut coverage and kick people off the rolls, and health care experts and advocates were quick to say how damaging and reckless this proposal could be for Tennesseans who rely on Medicaid.
Michele Johnson, Executive Director Of The Tennessee Justice Center, Said That The Proposal Would Be “Devastating For Our Health Care Infrastructure, For The Tennessee Economy, And For Our Communities.” “Michele Johnson, executive director of the Tennessee Justice Center, a group representing vulnerable residents needing health care and other assistance, said the proposed changes to TennCare would be ‘devastating for our health infrastructure, for the Tennessee economy, and for our communities.” [Washington Post, 9/17/19]
More Than Two Dozen Health Advocacy Groups Warned CMS That Block Grants “Will Reduce Access To Quality And Affordable Healthcare For Patients With Serious And Chronic Health Conditions.” “Moving to a block grant or per capita cap would also have widespread negative impacts on state economies. Cuts to Medicaid will not only impact those enrolled, but the entire healthcare system, as many critical healthcare entities, such as children’s hospitals, rely on Medicaid financing for their financial stability. The Affordable Care Act’s Medicaid expansion has led to significant reductions in uncompensated care costs and reduced the likelihood of hospital closures, especially in rural areas – progress that could be lost under block grant and per capita cap policies. Our organizations are concerned that CMS has not adequately considered these negative impacts. Finally, our organizations believe that the Administration does not have the authority to allow states to implement block grants or per capita caps through the 1115 waiver process. The Secretary is not permitted to waive Sections 1903 and 1905, where the financing structure of the Medicaid program is located, through these types of waivers. Such a change would require congressional authority, yet Congress has repeatedly declined to pass legislation on this issue, most recently during the debate over repealing and replacing the Affordable Care Act in 2017. Simply put, block grants and per capita caps will reduce access to quality and affordable healthcare for patients with serious and chronic health conditions and are therefore unacceptable to our organizations.” [American Lung Association et. al. letter to CMS Administrator Seema Verma, 7/18/19]
Nashville Tennessean: Governor’s Plan To Implement Block Grant Proposal Would “Almost Certainly” Change Medicaid Coverage. “The whole point of the block grant proposal is that Tennessee officials think they can run their state Medicaid program better than the federal government. If the block grant proposal is enacted, the state government would likely gain control over who is eligible for TennCare and which medications and treatment are covered. State officials could potentially decide to stop paying for a medication that is now covered or start covering a procedure that is currently outside the scope of TennCare.” [Nashville Tennessean, 8/25/19]
University Of Michigan Economist Nicholas Bagley Said Tennessee’s Block Grant Proposal Has “Dubious Policy Merits” And Isn’t “Close” To Being Legal. “Earlier today, Tennessee released a draft proposal to introduce block grants into its Medicaid program. Setting aside the dubious policy merits of block grants, however, I don’t think the proposal is legal. I don’t even think it’s close.” [The Incidental Economist, 9/17/19]
Robin Rudowitz, A Medicaid Analyst At The Kaiser Family Foundation, Said Block Grants Run Counter To “Core Principles” Of Medicaid. “’There are two foundational things in Medicaid—an entitlement for all individuals eligible for coverage, and a guarantee to states of federal matching dollars,’ said Robin Rudowitz, a Medicaid analyst at the Kaiser Family Foundation. ‘Block grants run counter to both of those core principles.’” [Modern Healthcare, 5/7/19]
Two Major Tennessee Hospital Groups Expressed Concern That Block Grant Proposal Would Weaken Health Insurance For Families. “Two major Tennessee hospital companies say a plan to convert billions of federal Medicaid funding to a block grant may weaken health insurance for poor families or cause TennCare to run out of money during an economic recession. […] For this story, The Tennessean contacted about a dozen Tennessee hospital companies seeking comment from their executives about the block grant proposal. Interviews were conducted with experts at Saint Thomas Health in Nashville and Baptist Memorial Health Care in Memphis, both of whom expressed concerns, and with the CEO of Ballad Health in East Tennessee, which was supportive.” [Nashville Tennessean, 9/12/19]
Republican State Senator And Cardiothoracic Surgeon Richard Briggs Said “A Straight Block Grant Could Be Very Dangerous.” “’A straight block grant could be very dangerous,’ said Briggs, who for the past few years has unsuccessfully pushed for Medicaid expansion under the Affordable Care Act. ‘If we go into a recession—and we’re due for one—there will be more people going into Medicaid, and the state would have to make up revenues to cover them.’” [Modern Healthcare, 5/7/19]
