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People Who Know Health Care Best Think “Block Granting” Medicaid is the Worst

By January 31, 2020No Comments

Yesterday, the Trump administration announced their new plan to encourage states to apply for so-called “block grants” that would gut Medicaid coverage and kick people off the rolls. Health care experts and patient groups swiftly denounced the plan, noting that the Trump administration’s plan is another “unlawful” attempt to strip health care from Americans after similar plans have been rejected by Congress time and again.  

Vice President Pence was asked about the new guidance by Dr. Rob Davidson in Iowa last night. Dr. Davidson — an emergency room physician — explained that his patients depend on coverage through Medicaid expansion to receive emergency and primary care. The vice president claimed he “hadn’t heard” about cuts to Medicaid and told Dr. Davidson that he was “oversimplifying” the harmful impact of the administration’s block grant guidance.

See the interaction between Dr. Davidson and Vice President Pence below:


Georgetown University Center for Children and Families Executive Director Joan Alker Said “The Misguided, Unlawful Guidance Issued By CMS Today Encourages States To Gamble With The Health And Well-Being Of Their Residents.” “The misguided, unlawful guidance issued by CMS today encourages states to gamble with the health and well-being of their residents and their budgets by trading in their guarantee of federal matching funds for a cap on federal funding on a portion of their programs. States already have a lot of flexibility in the Medicaid program. What this guidance does is to give states unprecedented new tools to make cuts to health care in their state. These cuts would also come with far less transparency and oversight.” [Georgetown Center For Children And Families, 1/30/20

Center On Budget And Policy Priorities: Medicaid “Block Grant” Guidance Will Likely Encourage States To Undermine Coverage. “Weakening that guarantee — or eliminating the federal standards and oversight that ensure that states, health plans, and providers comply with it — would worsen access to care, health, and financial security for beneficiaries and likely increase providers’ uncompensated care costs. Meanwhile, capping federal funding would likely shift costs to states, since they would be solely responsible for unexpected costs above the cap instead of sharing those costs with the federal government as they do today.” [Center On Budget And Policy Priorities, 1/29/20

Kaiser Family Foundation’s Larry Levitt Said “It’s Hard To See How This Could Help Patients.” “’The ‘opportunity’ here seems to be for states to limit benefits or drugs in Medicaid and pocket the savings,’ said KFF’s Larry Levitt. ‘It’s hard to see how this could help patients themselves.'” [Politico, 1/30/20

Leo Cuello, Director Of Health Policy At The National Health Law Program, Said “Apparently Desperate To Cut Health Care Coverage, The Administration Is Seeking To Fund Harmful Block Grants” “‘This is an underhanded attempt by the President to do what even a Republican Congress refused to do as recently as the failed Affordable Care Act repeal effort in 2017. People across the country in both political parties called their legislators and stopped that attempt to slash Medicaid,’ said Leo Cuello, NHeLP’s director of health policy. ‘After that failure, the administration attempted to circumvent Congress and transform Medicaid through other means such as restrictive work requirements, which courts so far have found illegal. Apparently desperate to cut health care coverage, the administration is seeking to fund harmful block grants. And make no mistake, these block grants would be devastating for any state that attempts to implement them, and any irresponsible state leader that pursues this policy will be acting against his or her state’s interests – harming the state budget, rural hospitals, state health insurance coverage—and the people who depend on Medicaid for their health insurance coverage.’” [National Health Law Program, 1/30/20

Joseph R. Antos, A Health Care Scholar At The Conservative American Enterprise Institute, Said That A Block Grant “Can’t Be Done.” “Joseph R. Antos, a health-care scholar at the conservative American Enterprise Institute, said the part of Medicaid law that allows states to get exceptions from the program’s usual rules does not allow federal health officials to waive the formula that defines the share of money the federal government and states provide. ‘Anything that sounds like a block grant,’ Antos said, ‘can’t be done.’” [Washington Post, 1/28/20

Sara Rosenbaum, Professor Of Health Law And Policy At George Washington University, Said That She Assumes The Trump Administration Is “Trying To Look Like They Are Helping Poor People, Without In Any Way Extending The Entitlement.” “‘Trying to get to the bottom of the politics of this is hard,’ said Sara Rosenbaum, a professor of health law and policy at George Washington University. ‘I assume that they are trying to look like they are helping poor people, without in any way extending the entitlement. It’s one of these sleights of hand where you’re trying to figure out exactly what’s at work.’” [New York Times, 1/30/20


American Lung Association, American Heart Association, And 25 Other Patient Groups Said Trump’s Block Grants “Will Reduce Access To Quality And Affordable Health Care For Patients With Serious And Chronic Health Conditions And Are Therefore Unacceptable To Our Organizations.” “Per capita caps and block grants are designed to reduce federal funding for Medicaid, forcing states to either make up the difference with their own funds or make cuts to their programs that would reduce access to care for the patients we represent. As the gap between the capped allotment and actual costs of patient care increases over time, states will likely limit enrollment, reduce benefits, lower provider payments or increase cost-sharing for patients. States are already moving forward with deeply troubling proposals in anticipation of today’s guidance promoting these limiting financing arrangements. Simply put, block grants and per capita caps will reduce access to quality and affordable health care for patients with serious and chronic health conditions and are therefore unacceptable to our organizations.” [American Lung Association, 1/30/20

The American Academy of Pediatrics, Children’s Defense Fund, Children’s Hospital Association, Family Voices, First Focus on Children, Georgetown University Center for Children and Families, March of Dimes and National Association of Pediatric Nurse Practitioners Said “At A Time When Child Uninsurance Is Already On The Rise, This Guidance Makes It Even Harder To Guarantee Children Can Get The Care They Need.” “Our organizations are united in opposition to any threat to Medicaid that would dismantle a pillar program millions of families rely on. At a time when child uninsurance is already on the rise, this guidance makes it even harder to guarantee children can get the care they need. We urge CMS to immediately rescind the guidance and keep Medicaid strong.” [American Academy Of Pediatrics, 1/30/20

AARP: Block Grants “Could Put At Risk The Health Coverage For Millions Of Vulnerable Americans.” “AARP is deeply concerned that new guidance released today by CMS letting states cap funding in the Medicaid program could put at risk the health coverage for millions of vulnerable Americans. Capping the program’s funding structure and limiting benefits and services could leave millions without the coverage and care they need.” [AARP, 1/30/20]  

American Academy Of Pediatrics: It Is “Baffling And Alarming That Such Drastic, Harmful Changes Are Being Proposed To A Program That Works So Well.” “Today’s guidance invites states to pursue policies that will leave patients worse off, including limiting how many prescription medications are available and cutting critical benefits, even before federal funding runs out. Children make up the single largest group of people who rely on Medicaid, including children with special health care needs and those from low-income families. Unlike many commercial insurance plans, Medicaid guarantees specific benefits designed especially for children. Simply put: Medicaid works. In fact, children in Medicaid are more likely to get check-ups, miss less school, graduate and enter the workforce than their uninsured peers.”It is therefore baffling and alarming that such drastic, harmful changes are being proposed to a program that works so well for such vulnerable groups. It is even more concerning that it was done in a way that does not allow those who would be impacted most to weigh in.” [American Academy Of Pediatrics, 1/30/20

Rick Pollack, President and CEO Of The American Hospital Association, And Mark Parkinson, President and CEO Of The American Health Care Association, Said That “Entire Communities Could Lose Access To Care Under This Proposal.” “The presidents and CEOs of the American Hospital Association and American Health Care Association, Rick Pollack and Mark Parkinson, immediately criticized the Trump administration guidance Thursday, warning that it could lead to a $50 billion national Medicaid funding cut. ‘Entire communities could lose access to care under this proposal, especially in rural areas where 15 percent of hospital revenue and nearly two-thirds of nursing facility revenue nationwide depend on Medicaid funding,’ Pollack and Parkinson said in a joint statement. ‘The supplemental payment programs targeted in this rule are also a critical lifeline at hospitals, health systems and nursing facilities that serve some of the most vulnerable Americans.’” [Modern Healthcare, 1/30/20

ASCO President, Howard A “Skip” Burris III, Said Transforming Medicaid Into A Block Grant Program Would Jeopardize Health And Outcomes For People With Cancer. “‘A transition to block grants could transform Medicaid from a safety net program, designed to meet basic health needs for low-income Americans, to a program with funding limits that drive care rationing for the most vulnerable,’ said ASCO President Howard A. “Skip” Burris, III, MD, FACP, FASCO…’ASCO recognizes that state and federal budgets are facing mounting financial pressures—including the rising cost of cancer care—but transforming Medicaid into a block grant program would jeopardize health and outcomes for people with cancer,’ said Dr. Burris. ‘Furthermore, reducing access to care such as recommended cancer screenings could actually end up increasing the cost of care when patients present to providers with more complex, late-stage illnesses.’” [American Society of Clinical Oncology, 1/28/20

Charles N. “Chip” Kahn III, President Of The Federation Of American Hospitals, Said That Block Grants Are “Based On The Assumption You Can Control Costs,” But “You Can Get A Curveball In There, And It Can Throw The Whole Thing Off.” “Democrats and large swaths of the health-care industry have consistently opposed block grants, contending that such fixed payments could strand states financially when the economy deteriorates, expensive new therapies materialize or public health disasters arise. Such pressures, critics contend, would lead states to cut eligibility or services. ‘These are all the reasons you’ve got to be nervous about a block grant,’ said Charles N. “Chip” Kahn III, president of the Federation of American Hospitals. “’It’s based on the assumption you can control costs and the levels of services are the same from year to year. You can get a curveball in there, and it can throw the whole thing off.’” [Washington Post, 1/28/20