Thursday, December 1, 2016

Quiet catastrophes: Medicaid block grants

While Trump distracts with visible nightmares, the hidden bad dreams are sneaking up. One of them is Medicaid block grants.

This benign-sounding administrative change to the mechanism of Medicaid funding is so wonky it's hard to explain why it's a horror show. The basic summary: you can set up federal funding for state-run programs in a couple of ways. One is the way Medicaid works now: the feds and the states divide up costs based on meeting the need, as need is defined by legislation and federal rules. Another is block grants: feds and states divide costs based on some pre-defined amount they decide they want to pay. Again, to simplify, this means that needs are defined by the pre-defined cost.

Medicaid block grants are not a new idea, as this 2005 Milbank Quarterly article explains. They are in fact a recurrent bad dream of Republican plots to tear up any social contract that includes caring about the well-being of poor people. And as the article explains, the only benefit they produce from a health policy point of view is creating predictability of federal spending; they would cause people to lose coverage and they would decrease the value of coverage. It's no exaggeration to say: over time, the block grant strategy will start killing people, and if left unchecked, will kill at a faster and faster rate as it evolves into progressive funding cuts.

Republican block grant promoters will say otherwise, but block grants are almost always a way to cut spending and ultimately, the value of programs. "[T]he most predictable result of merging social programs into broad block grants is substantial erosion in funding over time, with negative consequences for efforts to assist people in need," explains a recent think tank analysis.

Which is why, if you care about the well-being of poor people, there is only one kind of block you can support: the city block.

Tell 'em, Becky G:

That's Inglewood she's showing off; it has about a quarter of its people living in poverty. Obamacare's Medicaid expansion covers people up to 133% of the federal poverty level, so that includes a lot of folks in Inglewood.

So when you hear the phrase "block grant", think of Becky on the Block; and keep thinking of Inglewood: not only are there a lot of Medicaid recipients there, but California would be especially hard-hit by the block grant strategy.



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