Repealing the ACA under Trump

[RedDenver]

Here's some critiques of block grants:

https://www.nytimes.com/2017/02/06/upshot/how-would-republican-plans-for-medicaid-block-grants-actually-work.html

http://familiesusa.org/product/block-grants-bad-idea-medicaid

http://thehill.com/blogs/pundits-blog/healthcare/323252-gops-medicaid-block-grant-plan-should-trump-other-concerns

 

Summary:

Block grants just push the decision-making of Medicaid costs to the states in order to show a political victory at the federal level. States don't have the budgets to provide those costs especially during economic downturns, so it will effectively be similar to the system before Medicaid existed where the poor and disabled struggle to get healthcare.

[Danny Bateman]

That's the rub, as I understand it. Most states don't want more freedom... they want the federal dollar matches as high as they can be. More money trumps more freedom.

[TGHusker]

RD - thanks for the links. My thinking has been that block grants come with all of the fed money to implement. What the states don't like are mandates without the corresponding funding.

[TGHusker]

Here's some critiques of block grants:

https://www.nytimes.com/2017/02/06/upshot/how-would-republican-plans-for-medicaid-block-grants-actually-work.html

http://familiesusa.org/product/block-grants-bad-idea-medicaid

http://thehill.com/blogs/pundits-blog/healthcare/323252-gops-medicaid-block-grant-plan-should-trump-other-concerns

 

Summary:

Block grants just push the decision-making of Medicaid costs to the states in order to show a political victory at the federal level. States don't have the budgets to provide those costs especially during economic downturns, so it will effectively be similar to the system before Medicaid existed where the poor and disabled struggle to get healthcare.

1st article= interesting and actually kind of scary financial issues. No wonder congress is having such a hard time with this:

In the early 1960s, the programs had only 3.4 million beneficiaries nationwide.

The 1965 Medicaid law removed these caps, and today Medicaid covers about 81 million people, or about one in four Americans. By 1980, spending in the program had grown by a factor of 10, and many politicians began to panic about the cost. This rise appears to have come not as much from a rise in benefits or payments as a huge increase in enrollees.

Andrew Goodman-Bacon, an economist at Vanderbilt University and one of the authors of the article, told me: “From the time Medicaid began until 1980, the amount spent per Medicaid recipient went up about 68 percent. The number of enrollees, however, went up almost 700 percent. Moreover, since 1980, the amount spent per Medicaid beneficiary has been almost flat, at just under about $5,800.”

Given that the growth in Medicaid spending seems mostly because of increases in the number of people benefiting from the program, it seems logical that one of the few ways to cut spending is by reducing that number.

The fact that so much of the discussion about Medicaid block grants centers on cuts points to most policy makers’ assumptions that cuts will need to be made. According to the Center on Budget and Policy Priorities, the House Republican budget plan for fiscal year 2017 (if it had passed) would have led to a reduction in Medicaid spending by $1 trillion over a decade. By 2026, federal funding for Medicaid would be one-third less than under current law.

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From states’ point of view, whether they are reimbursed by a block grant or a percentage of coverage doesn’t really matter as long as the amount is enough. Almost no block grant plan allows for this, though. Planned cuts are how block grants make future federal budget projections look so good.

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.

2nd article. To many states currently have difficulty balancing their budget. If the block grants aren't fully funded, we'll see a Puerto Rico or Illinois crisis in every state. :

Updated January 23, 2017: President Trump and his advisors have indicated that they will pursue a Medicaid block grant as part of their attempt to repeal the Affordable Care Act.

Turning Medicaid into a block grant is not a new or innovative idea. As our fact sheet explains, block granting Medicaid would ultimately mean cuts in services to people who need health care most.

A “block grant” is a fixed amount of money that the federal government gives to a state for a specific purpose. If Medicaid was turned into a block grant, the federal government would set each state’s Medicaid spending amount in advance. That amount would presumably be based on some estimate of state Medicaid spending, but most block grant proposals start with significant cuts in federal Medicaid support.

Why are block grants harmful?

• If a state’s costs exceed the amount of the block grant, it will have to use its own funds to make up the difference, or, more likely, cut services for low-income residents.
• Counter to what proponents claim, block grants don’t give states more flexibility with their Medicaid programs.
• Block grants would make it harder for states to serve their residents’ health care needs.

 

Summary: Congress needs to get back to the drawing board. They own it now and pushing it off to the states will not help in the long run.

[zoogs]

"This is the end of single payer healthcare" -- I think this illustrates Graham's intentions very clearly.

I don't know too much about the states proposal, but I agree with you guys. I don't see the benefits. I do see how it fits in the whole 'federalism' framework, but is federalism for federalism's sake really addressing healthcare?

"If they can’t, though, they will have to make do with less, make the hard choices and face the brunt of the blame."

It sounds like Graham has awareness of the difficulty of this problem -- and wants a tidy way to offload responsibility, as a federal and not state-level legislator. It does seem remarkable though the extent to which he seems willing to spend federal dollars on this. That's a stone's throw away from spending a bit more to get to the right solution. Will he oppose single payer forever?

[Kiyoat Husker]

CBO estimates Sanders' Safe and Affordable Rx Drug Importation Act would save $6.8B over the next decade

 

Intriguing.

 

Once again, common-sense legislation that would lower costs, and has bi-partisan support, is killed by big-money lobbying:

 

...Democrats Patty Murray (WA) and Michael Bennet (CO), two big beneficiaries of pharma campaign cash, voted against it in committee, and it failed 13-10.

Overall, campaign spending by the pharmaceutical industry isskyrocketing.

 

Sickening.

[NM11046]

So - if you're telling me that I might go to a conference with colleagues from all over the US and each of us would have a different benefit package?

 

What if I moved from Iowa to Missouri?

 

Wouldn't everyone that could (especially sick folks) just relocate to the state with the best healthcare insurance? Do you then (like some universal healthcare offers in Europe) make it contingent on someone living in the area for a certain amount of time before they are able to qualify? What do they do in the mean time?

 

As some of you already deduced, this is a cop out by Senate to essentially wipe their hands of a mess. Cowards.

[NM11046]

 

CBO estimates Sanders' Safe and Affordable Rx Drug Importation Act would save $6.8B over the next decade

 

Intriguing.

 

Once again, common-sense legislation that would lower costs, and has bi-partisan support, is killed by big-money lobbying:

 

...Democrats Patty Murray (WA) and Michael Bennet (CO), two big beneficiaries of pharma campaign cash, voted against it in committee, and it failed 13-10.

Overall, campaign spending by the pharmaceutical industry isskyrocketing.

 

Sickening.

Do we know why they voted against it? Sincerely asking, perhaps your assumption is right (that they were bought) but I heard snippets of Jake Tapper pushing Bernie on some of the gaps his plan presents this weekend, so I know there are some areas where it's not perfect.

[Kiyoat Husker]

 

 

CBO estimates Sanders' Safe and Affordable Rx Drug Importation Act would save $6.8B over the next decade

 

Intriguing.

Once again, common-sense legislation that would lower costs, and has bi-partisan support, is killed by big-money lobbying:

 

...Democrats Patty Murray (WA) and Michael Bennet (CO), two big beneficiaries of pharma campaign cash, voted against it in committee, and it failed 13-10.

Overall, campaign spending by the pharmaceutical industry isskyrocketing.

Sickening.

Do we know why they voted against it? Sincerely asking, perhaps your assumption is right (that they were bought) but I heard snippets of Jake Tapper pushing Bernie on some of the gaps his plan presents this weekend, so I know there are some areas where it's not perfect.

 

 

Well, Its not my assumption. I'm just conveying the insinuation from the article. It is discussed at-length there. You are right, though, that there is technically no proof. It is interesting that some members of both parties have voted for and against the bill, so partisanship is less of an issue. The pattern, if there is one, is that legislators with large pharma donations are voting against it.

 

Also, I don't see any interview with Jake Tapper about Bernie's affordable drug bill. There is one recently where he is talking about single payer...

[QMany]

[Danny Bateman]

 

It's so frustrating when they have a built-in out on this. They'll just lie and blame it on the ACA. And millions will believe them.

 

Still, it is heartening to have data to back up what others have been saying, rightfully, for a long time.

[BigRedBuster]

[funhusker]

^^^I would just like to go on the record and say "not it".

 

 

Just in case.....

[BigRedBuster]

 

[knapplc]

^^^ That's so weird! It's almost as if he has no idea what he's doing!

 

 

 

 

 

"Nobody knew that health care could be so complicated."

- Donald Trump

 

 

 

^^ Still my favorite Trump quote