The Trump Administration’s Cruelty Knows No Limits. Here’s the Latest.

In Healthcare On

When President Trump and Republicans in Congress failed in their 2017 attempt to repeal the Affordable Care Act, it was in no small part because repeal would have wiped away the ACA’s expansion of Medicaid. They probably believed that it wouldn’t be such a big deal. After all, it’s a program for poor people, right? Who cares about them?

What they found out, through an outpouring of protests and angry responses from constituents, was that Americans care quite a bit about Medicaid. There are now more than 71 million people on Medicaid and its subsidiary, the Children’s Health Insurance Program (CHIP). Medicaid is overwhelmingly popular, and nearly all of its recipients like it.

Repealing the ACA would have kicked 15.4 million Americans off their Medicaid and CHIP coverage, according to one analysis. And when they couldn’t do it through legislation, the administration supported a preposterous lawsuit filed by Republican-led states in hopes that the Supreme Court would do it for them (it’s still pending).

But failures and delays have not quenched the Republican thirst to kick people off Medicaid. So Wednesday, the administration announced that it is allowing any states that want — i.e., states run by Republicans — to take a sledgehammer to Medicaid.

They’ll do this primarily by converting it a “block grant” from its current status as an entitlement. The way an entitlement works is that the program’s budget is not capped; if, in December, a new person applies and they qualify, then they’re entitled to coverage. Under a block grant, that would no longer be true; the state would get a block of money, and if it runs out, too bad. Politico’s Dan Diamond and Rachel Roubein explain what the administration is doing:

The forthcoming block grant program comes with a new name — “Healthy Adult Opportunity” — but retains the original mission long sought by conservatives: allowing states to cap a portion of their spending on Medicaid, a radical change in how the safety net health program is financed.
The block grant plan, which invites states to request capped funding for poor adults covered by Obamacare’s Medicaid expansion, also would let states limit health benefits and drugs available to some patients.

So states would be allowed to turn away qualified applicants, limit health benefits and deprive people access to medications they need. That’s “Healthy Adult Opportunity” in the same sense that if I shoot you in the kneecap, I’ve given you “Mobility-Enhancing Pain Relief.”

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