Medicaid beneficiaries could
be at risk of losing health coverage if President-elect Donald J. Trump and a
Republican-controlled House and Senate follow through on their promises to cut Medicaid
spending and transform the state-federal program, which provides health care
for low-income Americans.
The new Administration and
Congress have several policy options at their disposal that could dramatically
impact funding for the Medicaid program. Three of the proposals that have been
mentioned during the campaign season are highlighted below.
Repealing the ACA and the
Impact on Medicaid Expansion
Both President-elect Trump
and House Speaker Paul Ryan (R-WI) have vowed to work to repeal the Affordable
Care Act (ACA). Thirty-one states and Washington, D.C., expanded Medicaid
eligibility under the ACA, adding approximately 15.7 million people to the
program. According to the Centers for Medicare and Medicaid Services,
approximately 64 million people were covered under Medicaid in 2015.
Trump’s vow to work with GOP majorities in the House and Senate to repeal the
ACA could create a problem for pro-expansion Republican governors whose
residents would lose benefits if the law were repealed. Among them, Vice
President-elect Mike Pence (Healthy Indiana Plan 2.0) and vocal Trump supporter
Chris Christie (New Jersey Family Care) who both accepted funding
from the federal government to expand Medicaid to cover hundreds of thousands
of low-income adults in their respective states.
President-elect Trump and
Speaker Ryan have discussed transforming the Medicaid program into a block
grant. Under the current Medicaid program, coverage is guaranteed for everyone
who’s eligible. The states’ obligation is to cover certain groups of people and
to provide specific benefits.
However, if federal funds
flow to states through block grants, states would have more flexibility to run
their Medicaid programs as they wish—including cutting benefits and
eligibility. Supporters of block grants contend that the new system would allow
the federal government to spend less on Medicaid and make states responsible
for covering costs beyond their federal allotments. Although transforming
Medicaid into a block grant program has been discussed for decades, the policy
has always been met with strong opposition from some states, health providers,
health care advocates and Democrats.
Per Capita Caps
Another option to reform
Medicaid funding is known as a per capita cap. Under this policy option, states
would be given a set amount of money per enrollee, which would increase each
year, but some argue the increase may not keep up with rising health expenses. However,
potentially, under this type of funding policy, as enrollment grows so would
The Children’s Health
Funding for the Children’s
Health Insurance Program (CHIP) is set to expire at the end of September 2017. Members
of Congress could pass a two-year extension, however supporters of the program
that provides health insurance to low-income children would prefer a longer
approval. CHIP’s legislative authority will expire in 2019, as will
requirements that prevent states from making it more difficult for people to
enroll in the program. The levels at which the program is funded will also be a
point of contention in Congress because the ACA, which President-Elect Trump
vows to repeal, provided states with a 23 percentage point boost. CHIP
advocates are pushing for Congress to extend the funding in the spring to give
state legislatures that adjourn early in the year time to determine their
health budgets. In 2015, 8.4 million children were enrolled in CHIP, thus
qualifying for free or low-cost health and dental coverage.