Today, the Trump administration continued their quest to sabotage Medicaid by announcing new guidance encouraging states to apply for so-called “block grants” that will gut coverage and kick people off the rolls. Press reports quickly pointed out that millions will be hurt and that Congress has resoundingly rejected this proposal many times. 

New York Times: Administration Offers Plan For Medicaid Block Grants, Long A Conservative Goal. “Republicans have proposed block grants in various forms for decades, going back to the Reagan administration…More recently, Republicans’ bills to repeal and replace the Affordable Care Act in 2017 proposed giving states a choice between a fixed annual sum per Medicaid recipient or a block grant, both of which would have almost certainly led to major cuts in coverage over time. Concerns from moderate House Republicans about the potential of deep cuts to Medicaid — which now serves more than 71 million people, or more than 1 in 5 Americans — helped doom the repeal effort.” [New York Times, 1/30/20

Vox: Trump’s Audacious New Plan To Cut Medicaid, Explained. “Medicaid would no longer pay whatever is necessary to provide medical care to the people in or near poverty who qualify for its benefits. Instead, spending would be limited in states that got a waiver from the federal government, and they could impose cuts on benefits. Trump has already tried to fundamentally alter the Medicaid program through work requirements, though he’s been stopped in the courts. But the block grants represent an even more basic remaking of Medicaid on his watch, one that would lead to spending cuts and fewer benefits.” [Vox, 1/30/20

Vox: Like Work Requirements, Trump’s Block Grants “A Roundabout Way To Roll Back Obamacare’s Expansion Of Medicaid Specifically.” “The block grants are also, like work requirements, a roundabout way to roll back Obamacare’s expansion of Medicaid specifically. Under the guidance released by CMS, it would be benefits for people newly eligible under the health care law — mostly childless adults and parents who are living in or near poverty — that would be subject to the block grants. In that context, despite Trump’s campaign promise not to cut Medicaid, these policies make sense as a means to an end for the conservatives whom Trump has put in charge of his health department.” [Vox, 1/30/20

Vox: “Trump’s Record On Medicaid Is Quite Clear: His Administration Continues Pursuing Legally Dubious Changes That Would Scale Back The Program.” “ Trump’s record on Medicaid is quite clear: His administration continues pursuing legally dubious changes that would scale back the program. Before courts put them on hold, his work requirements led to 17,000 people in Arkansas losing Medicaid benefits, without any noticeable improvement in employment.” [Vox, 1/30/20

Washington Examiner: Trump To Let States Overhaul Medicaid For The Poor, Seeking To Change Obamacare Without Legislation. “Thursday’s move is the latest example of Trump administration efforts to overhaul Obamacare after the Republican-controlled Senate failed to pass legislation to do so in 2017.” [Washington Examiner, 1/30/20

Politico: “The Plan Is The Administration’s Boldest Step Yet To Curb Medicaid Spending And Shrink The Program.” “The plan is the administration’s boldest step yet to curb Medicaid spending and shrink the program covering about 1 in 5 low-income Americans. But the move is inciting fierce opposition from Democrats who say it’s the latest evidence President Donald Trump is trying to sabotage health coverage.” [Politico, 1/30/20

Politico: “Congress Rejected A Similar Block Grant Proposal After Analysts Found It Would Result In Millions Losing Coverage.” “During the failed effort to repeal and replace Obamacare in 2017, Congress rejected a similar block grant proposal after analysts found it would result in millions of people losing coverage…The health care law — and in particular its Medicaid expansion — remains popular after the failed effort to replace it during Trump’s first year in office. Nearly three-quarters of states have expanded Medicaid since 2014, and support for the program has boosted Democratic candidates in conservative strongholds.” [Politico, 1/30/20

Politico: “Block Grants Have Been A Regular Feature In Republican Health Plans Dating Back To The 1980s,” But “There’s Never Been Enough Support For The Idea From Congress.” “Block grants have been a regular feature in Republican health plans dating back to the 1980s. Republicans say that states can better manage the programs on a defined budget and fewer rules set by Washington. However, Medicaid advocates say a block grant would limit states’ ability to respond to economic downturns and expensive new drugs, forcing them to trim their programs. There’s never been enough support for the idea from Congress.”  [Politico, 1/30/20

The Hill: “The Move Is Likely To Kick Off A Furious Legal Fight.” “The move is likely to kick off a furious legal fight. Democrats have been arguing the administration doesn’t have the authority to approve such drastic changes, and Medicaid advocates argue the changes would hurt low-income people and invite states to cut costs and reduce coverage.” [The Hill, 1/30/20

Block Grant Guidance Would Allow States To Impose Work Requirements And Cost Sharing And Premiums Without Additional Federal Approval. “States will have the ability to spend it however they see fit, without some federal guidelines. For example, the program will allow states to impose work requirements, cut provider payments, and require cost sharing and premiums without additional permission from the federal government. Notably, states will be able to adopt what is called a ‘closed formulary’ for certain drugs. This means a state can decide not to cover a Food and Drug Administration-approved drug if there is a cheaper alternative.” [The Hill, 1/30/20

The Hill: Allowing States To Impose Block Grants “Would Be Extremely Controversial And Have Widespread Implications About The Use Of Executive Power.” “Congress already rejected block grants when the GOP’s ObamaCare repeal bill failed in 2017. Allowing states to impose those same changes by statutory waiver would be extremely controversial and have widespread implications about the use of executive power.” [The Hill, 1/30/20

Modern Healthcare: Block Grants Could “Lead To Significant Coverage Losses And Reduce Access To Care For Some Of The Most Vulnerable Populations.” “Healthcare experts worry that under a block grant, states might have to slash their Medicaid rolls or payments to disproportionate-share hospitals to get program spending under control. That could lead to significant coverage losses and reduce access to care for some of the most vulnerable populations. It could also hurt doctors and hospitals by increasing the amount of uncompensated care that they provide.” [Modern Healthcare, 1/30/20

Wall Street Journal: Trump Administration to Give States Wide Latitude in Medicaid Block-Grant Plan. “The Trump administration on Thursday released details for how states can apply to convert Medicaid to block grants that would let them impose changes such as eligibility requirements and prescription drug limits for millions of adults in the program…A legal row over the changes is likely. Democrats say the administration lacks the authority to approve structural changes to Medicaid that they say would hurt enrollment. Consumer advocates say the changes, including the limits on federal funding, hurt the poor.” [Wall Street Journal, 1/30/20

Wall Street Journal: “A Republican-Led Push To Repeal The Affordable Care Act In 2017 Largely Failed Because It Included A Plan To Block-Grant Medicaid.” “Efforts to convert Medicaid to block grants have been contentious. A Republican-led push to repeal the Affordable Care Act in 2017 largely failed because it included a plan to block-grant Medicaid. Analysts said millions of people would lose health coverage. Democrats and consumer advocates say the new changes threaten enrollment gains seen under the former Obama administration and violate federal law.” [Wall Street Journal, 1/30/20

Politico: ‘Block Grants’ No More: Trump’s Medicaid Overhaul Has New Name, Same Goals. “The forthcoming block grant program comes with a new name — ‘Healthy Adult Opportunity’ — but retains the original mission long sought by conservatives: allowing states to cap a portion of their spending on Medicaid, a radical change in how the safety net health program is financed. The block grant plan, which invites states to request capped funding for poor adults covered by Obamacare’s Medicaid expansion, also would let states limit health benefits and drugs available to some patients.” [Politico, 1/29/20

Paul Waldman In The Washington Post: The Trump Administration’s Cruelty Knows No Limits. Here’s The Latest. “So states would be allowed to turn away qualified applicants, limit health benefits and deprive people access to medications they need. That’s ‘Healthy Adult Opportunity’ in the same sense that if I shoot you in the kneecap, I’ve given you ‘Mobility-Enhancing Pain Relief.'” [Washington Post, 1/29/20

Paul Waldman In The Washington Post: “Verma Has Made No Secret Of The Fact That She’d Like To Have As Few People Getting Medicaid As Possible.” “Block-granting has long been a conservative goal, but Seema Verma, whom Trump named to run the Medicare and Medicaid programs, has taken to it with a particular relish. Verma has made no secret of the fact that she’d like to have as few people getting Medicaid as possible, and every time someone loses their coverage, as far as she’s concerned, it’s a victory.” [Washington Post, 1/29/20

Paul Waldman In The Washington Post: “We Can Be Sure That Every Day This Administration Is In Office, It Will Try To Take Health Coverage Away From As Many Americans As It Can.” “We can’t know what the future of the ACA is (though my suspicion is that knowing what a catastrophe it would be for the Republican Party if they actually succeeded in their lawsuit, Chief Justice John G. Roberts Jr. will step in and vote with the liberal justices to save his party from itself). But we can be sure that every day this administration is in office, it will try to take health coverage away from as many Americans as it can.” [Washington Post, 1/29/20