The Choice Facing a Declining United States
The choice for states
The choice for states
A fundamental change
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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