The Choice Facing a Declining United States



The choice for states

The choice for states

A fundamental change

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While the BCRA and the AHCA would phase out the Medicaid expansion established by the Affordable Care Act — which extended the program to those making 100% to 138% of the federal poverty limit — both proposals call for a fundamental change in how Medicaid operates.

Since its establishment in 1965, Medicaid has been an open-ended entitlement program. Anyone who meets the eligibility requirements has a right to enroll, and if costs go up because of new, expensive treatments or increasing healthcare needs, states receive more federal money. While states fund a big portion of their individual Medicaid programs, the federal government matches up to a certain percentage, with bigger matches for poorer states.

Both bills would change Medicaid to a program where funding would be set on a per-capita basis — meaning the federal government would send states a fixed amount of money per Medicaid enrollee, regardless of whether that would cover needs or care — and then peg funding growth to a rate related to inflation.

"It's no longer an open-ended matching program," Richard Frank, a professor at Harvard Medical School professor, told Business Insider in May. He added that changing funding to per-capita cap grants "fundamentally changes the kind of contract that exists between the states and the federal government."

The BCRA would take it a step further.

The AHCA called for growing funding by consumer price index for medical care (CPI-M), generally a figure between 2% and 5% each year. The Senate's bill, meanwhile would grow the figure initially by CPI-M before switching to the CPI for all goods (CPI-U)— a significantly lower level of growth — in 2025.

The switch from CPI-M to CPI-U would mean far more restrictive growth for Medicaid funding.






Video: DUP Conference: Arlene Foster states the choice is “not between this deal and no-deal”

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Date: 13.12.2018, 08:17 / Views: 85591