EXPLAINER: How Would Republican Plans for Medicaid Block Grants Actually Work?


There’s no magic in how Congress reduces spending under a block grant mechanism. It just says it will do so, and leaves the hard decisions to others. It’s possible that some states will come up with solutions we haven’t been able to see before, and find a way to reduce spending without causing problems. If they can’t, though, they will have to make do with less, make the hard choices and face the brunt of the blame.


Block grants are simple: states are given a set amount of money to sustain their Medicaid population. If their needs exceed that amount, the state has to come up with the difference or make cuts: to recipients, services, or costs covered. States that rely on a higher percentage of federal dollars for Medicaid are more likely to come up short in this equation. Many of these states have things in common. They are poorer, health disparities greater, outcomes worse. The fear is that these states, already behind, will slip further if a gap in funding grew. It disconcerts me greatly that Americans are resigned to the great divides that exist among us in health measures and life expectancy. Block grants forewarn of further disengagement of rich from the poor, North from the South, urban from rural, one race from another. Our federal government and it’s protective policies and programs unite us, remind us that we are in fact one nation, interdependent.

Sometimes I pledge allegiance to bureaucracy. When it seems nothing is fair and  equal, it comes in with it’s obstinate rules, enforcing equality. Leveling us all out.

The Times article above is a solid explainer and good read. I’m hopeful that Medicaid, with its remarkable approval rating, fundamental role in access to care for those who are poor or out of a job or disabled (even temporarily), is a critical piece of health care infrastructure. Rather than cut it off at the knees, let’s give it some nurture. There is a lot to be learned from its successes.

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