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Title : By Refusing To Implement The Medicaid Expansion Republican Governors May Locomote Making The Republican Block Grant Proposals Impractical
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By Refusing To Implement The Medicaid Expansion Republican Governors May Locomote Making The Republican Block Grant Proposals Impractical

Paul Ryan's Medicaid block grant proposals own got ever made feel to me. Give the states their Medicaid allocation together with existent flexibility over how they pass what volition inevitably hold upwardly less federal money.

But equally I own got sentiment nearly the affect of implementing the Medicaid expansion nether the Affordable Care Act ("Obamacare"), Medicaid block granting is looking to a greater extent than together with to a greater extent than problematic.

Under the novel wellness law, together with the resulting Supreme Court determination over the law, states own got the pick of expanding their Medicaid programs on Jan 1, 2014. Listening to all of the governors, it looks similar nearly three-fourths of the states volition expand their programs together with possibly one-fourth volition not. So far nine states are inwards the no column.

Those governors against the expansion are all conservatives objecting to entitlement expansions when these same entitlements are sinking the national financial outlook.

Ryan's Medicaid proposal would develop a baseline for federal Medicaid payments to states together with restrict their increase inwards hereafter years. His proposals final twelvemonth were vague on how he would develop that baseline but his before 2010 proposal, alongside Alice Rivlin, was to a greater extent than specific:

In central for slower growth inwards the Federal government’s Medicaid payment, states volition own got to a greater extent than flexibility inwards how they purpose Medicaid funds to encounter the needs of their low-income populations.

Each state’s initial allocation would hold upwardly determined past times the state’s per capita low-income population based on Federal Poverty Level. The province allocation would grow at gross domestic product +1 per centum together with would hold upwardly farther adjusted for population growth.

If a 4th of the states did non expand their Medicaid programs nether the novel wellness police together with three-fourths did, only how would the baseline initial allocation for each state's part of the federal toll of Medicaid hold upwardly determined?

The states expanding would own got a far higher Definition of "low income" than those that had non expanded.

Would a novel Ryan Medicaid block grant proposal practise only i Definition for who was eligible? If hence would it await to a greater extent than similar the states that hadn't expanded or those that did?

If the Definition looked similar the novel wellness law's Medicaid eligibility levels, together with hence all of the governors who originally passed on the expansion would own got done it for zip together with Medicaid block grants would toll the province to a greater extent than because of the take away to equalize the states that had originally passed on the expansion.

If the baseline were to reverberate the toll for states pre-expansion, together with hence three-fourths of the states would hold upwardly inwards for huge Medicaid cuts––hardly politically realistic.

Post Jan 1, 2014, alongside three-fourths of the states potentially at i Medicaid spending marker together with a 4th at a much lower level, only how practise you lot practise a fair Medicaid baseline on which block grants could begin?

Ironically, those loyal conservative "red state" governors belongings the business on entitlement expansion may good either hold upwardly setting their ain Medicaid reform proposals upwardly for becoming impractical or these same governors volition own got to eventually convey the novel "Obamacare" Medicaid baseline to brand the Medicaid block grant sentiment politically acceptable.


Earlier post: The Medicaid Controversy––The Republican Governors Should Put Up or Shut Up

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