The most important thing he highlights is that state control of Medicaid programs ultimately means there is no longer a right to care once you get into the specifics. What Medicaid will pay for will be the states' responsibility--or lack of responsibility. In the long run, if a state wants to restrict or even eliminate necessary treatment, it may. This is another dark side to block grants, beyond the simple funding cuts. That is, saying "the states know best" not only is a cover for cutting budgets, but a cover for justifying bad care.
This is a crucial argument that needs to be highlighted more clearly, to emphasize that although Medicaid block grants are most broadly a way of enacting cruel budget cuts, they have the potential to more specifically accomplish other terrible and pernicious policy aims as well.
* * *
Sufjan Stevens' "Casimir Pulaski Day" is a stunning song, more and more stunning the more I listen to it, and I've been listening to it for a few years now. It's about a kid whose friend-kinda-girlfriend dies of "cancer of the bone"; and the way that event makes life and the universe more sad and complicated for everyone around her.
And maybe we just leave it at that.
Or maybe we return to point out that for people with rare diseases, block grants have the potential to...
...Or not. Maybe sometimes it's best to just let the song be the song.