Regular readers know that no one has been more critical of Obamacare's flaws––particularly over the impact the program has had on middle class consumers in the individual health insurance market.
And, readers already know that no one has been more supportive of the Medicaid expansion from the very beginning.
Now, the Trump administration wants to give states the option to abolish the open-ended federal funding of Medicaid via fixed block grants for only a small portion of those eligible, or potentially eligible.
Critics argue that by fixing these funds, particularly at a growth rate lower than paid in the past, will result in less money and if there is less money there will be fewer benefits and fewer people covered given the flexibility states would have to redefine the program.
That is a logical conclusion.
But it's a lot more complicated than that.
The Trump administration counters that the block grant option is "available to states for an important but limited population: working-age adults who are not eligible on the basis of a disability and for whom Medicaid coverage is optional — currently about 15 million people. The other 56 million beneficiaries would not be directly affected."
Block grant supporters point to skyrocketing state Medicaid budgets and believe that giving states the flexibility to innovate will eventually lead to a far more efficient and sustainable system.
The Trump proposal would enable states to choose to accept either a single annual lump-sum payment, or a lump-sum payment based on the number of able-bodied adults in that state’s Medicaid program. The proposed block grant program would not apply to people traditionally eligible for Medicaid, such as children, pregnant women or people with disabilities.
The Obamacare Medicaid expansion made all those uninsured, able-bodied or not, and living on under 138% of the Federal Poverty Level (FPL)––which is $17,236 for a single person––eligible for coverage if their state chose to expand .It is important to understand that most of the fourteen states, that have not expanded Medicaid for this target population under Obamacare, currently have some of the most draconian income limits to determine which of the able-bodied can qualify for Medicaid benefits.