Republicans are preparing to make dramatic changes to Medicaid if they win control of the White House and Congress in the upcoming election, the Los Angeles Times reports.
Many Republican governors already are attempting to roll back coverage in the wake of the Supreme Court decision to allow states to opt out of the Affordable Care Act's Medicaid expansion.
Meanwhile, congressional Republicans -- with the support of conservative activists -- are pushing to convert Medicaid into a block-grant program. Presumptive Republican presidential nominee Mitt Romney supports a block-grant plan, which effectively would reduce federal spending on the program by $1.5 trillion over 10 years.
A block-grant system -- which would give states the power to design their own programs and decide on eligibility -- has been a "long-held conservative dream," the Times reports. House Republicans already have approved legislation by Rep. Paul Ryan (R-Wis.) that included a plan to convert Medicaid into a block-grant program, but the bill stalled in the Senate.
Virginia Gov. Bob McDonnell (R), chair of the Republican Governors Association, said states could handle the reductions, adding, "If the federal government would take off a lot of the micromanagement and the bureaucracy ... we could probably get by with even less money."
Concerns About GOP Plans
The future of Medicaid is "unclear" should the GOP successfully switch it to a block-grant system, according to the Times. Earlier this year, the Congressional Budget Office concluded that it would be difficult for states to maintain Medicaid under Ryan's proposal.
"Even with significant efficiency gains, the magnitude of the reduction in spending ... means that states would need to increase their spending on [Medicaid and CHIP], make considerable cutbacks in them, or both," a CBO report on the legislation said.
According to the Times, even some Republicans warn that simply cutting federal contributions to Medicaid and giving states more flexibility "is unlikely to solve the Medicaid problem." Tom Miller, a scholar at the American Enterprise Institute and a former economist for the Joint Economic Committee, said, "States are not about to dig up a bunch of money on their own," adding, "And this is not a population that is just going to go away."
Meanwhile, many health care providers say cutting the program would increase the number of uninsured residents.
Bruce Siegel, president of the National Association of Public Hospitals and Health Systems, said, "We know that coverage saves lives" (Levey, Los Angeles Times, 7/30).
Majority of U.S. Residents Favor Medicaid Expansion, Survey Finds
Sixty-seven percent of U.S. residents have a favorable view of the health reform law's Medicaid expansion, according to a Kaiser Family Foundation poll released Tuesday, Reuters reports.
The report found attitudes about the expansion were divided along party lines, with nearly 90% of Democrats and 66% of independents supporting the expansion, and 60% of Republicans opposing it.
Support declined to 49% when participants were asked if they want Medicaid expanded in their own states (Morgan, Reuters, 7/31).
Mann Says States Ultimately Will Participate in Expansion
At a Bipartisan Policy Center forum on Monday, Cindy Mann, deputy administrator of CMS, said she believes states will spend the coming months analyzing whether to participate in the ACA's Medicaid expansion, but ultimately will opt in, Reuters reports (Morgan, Reuters, 7/30).
In the meantime, Mann said she will not respond individually to the hundreds of questions from state officials and health policy experts she has received since the Supreme Court ruling. Instead, she said she wants to think about all the questions comprehensively (Adams, CQ HealthBeat, 7/30).