Since LBJ signed into law health insurance for elderly people in July, 1965, Medicaid has grown from an oversite, thought to care only for the poor, to the providence of some 74 million Americans–1 in 5–covering their needs from the womb to the grave. Thus, Medicaid is now central to the nation’s healthcare system.
Moderate Republicans were unwilling to gamble with deep cuts in Medicaid and therefore helped doom the GOP’s drive to “Repeal & Replace” the Affordable Care Act (“ACA”) aka “Obamacare.” Representative Frank LoBiondo (R-NJ), a centrist, noted that almost 1 in 3 of all his constituents were covered by Medicaid. Likewise, Senate Republicans and Republican state governors expressed worry about jeopardizing care for the working poor, children and people with disabilities, and reducing funding for the care of elderly people in nursing homes.
Last week’s doomed GOP bill that would largely have undone the ACA would have ended the open-ended federal funding of the largest share of states’ Medicaid costs and replaced the same with block grants. Block grants were not precisely stipulated, thus the concern that some states would be treated differently or more unfairly than others (see Georgia’s Nathan Deal’s expressed concerns). Moreover, the unanswered question of what states would do if their block grant money ran out in say, month 9 of a 12-month period–simply tell recipients that their care wouldn’t be covered for the last 3 months? Block grants or a fixed-annual sum per recipient were the two options available and either would have clearly led to major cuts in coverage over time.
Nevertheless, many GOP governors and members of Congress intend to continue efforts to curtail Medicaid due to budgetary concerns. In 2015, the total cost of Medicaid nationally was more than $532 billion. The federal government funded about 2/3 (63%) of that and the states picked up the remainder. But, last week’s defeat of the GOP’s AHCA shows how difficult it is to take away an entitlement. This reality prompted Vermont’s Bernie Sanders to again promise to introduce a single-payer act in Congress. Indeed, California is actively considering a single-payer system for its healthcare needs. States often have different names for the program, but whether you know it as Medi-Cal, MassHealth,or TennCare in Tennessee, it’s just Medicaid by another name. And the percentage of people who support cutting Medicaid spending has never exceeded 13%. Even Donald J. Trump recognized Medicaid’s political potency during his campaign, when he declared that Medicaid should be saved “without cuts” and repeatedly Tweeted support for Medicaid, stating as “wrong” Republicans who wanted to cut Social Security and Medicaid.
Medicaid pays for nursing home care and other long-term care for more than 6 million Americans older than 64 years. But the Republican bill, the AHCA, would have only allowed Medicaid payments to grow per recipient at an inflation rate less than the true inflation rate of health care costs. Thus, the AHCA would have eroded benefits over time. Beneficiaries would have had to re-enroll every six months instead of annually. This threat to the elderly led Florida Representative Daniel Webster to vote “No” on the legislation. Central Florida constituents in one retirement center alone, The Villages, number greater than 150,000 residents. So, even as Medicaid has gained some hint of a stigma with all the political polarization from the Obama years, the reality that some people can’t afford health insurance whether or not they were “able-bodied” and working has caused even Republican-led states to expand Medicaid coverage. The expansion has helped with the opioid epidemic, birth defects, and the fact that 10,000 Baby-Boomers per day are still turning age 65. So, despite the stigma that, “people don’t deserve [free care],” no one wants to see someone they know lose their healthcare due to unaffordable costs. Perhaps equally as important, Republicans recognized that any bill that would lead to drastic cuts in Medicaid would simply hurt too many of their constituents.