Looking Forward: Possible Policy Changes in Medicaid/Medicare

This last month has been a whirlwind of activity and conflict as the newly elected president and congress have clashed over potential changes to the Affordable Care Act and health insurance. Many Americans are wary of what sorts of agenda items might be upcoming, and how it will affect them. It is likely that one of the next big items that the federal government will be legislating will be Medicare and Medicaid.

As these are issues that are constantly in flux, I would encourage you to do independent research for the most up-to-date information.

What stand do the federal authorities take on Medicaid?

Medicaid is an issue that might cause conflict between President Trump and the Republican-controlled congress. President Trump has repeatedly stated that he wants to protect Medicare and Social Security. Though he might consider some reform or modernization of the system, he has repeatedly stated that he wants to “save” Medicaid by eliminating waste in other areas, or possibly by switching the funding mechanism.

On the other hand, much of the Republican leadership has been calling for a more expansive overhaul of Medicaid via entitlement reform, which could lead to a drastic change in how many individuals are covered, and at what cost.

What reforms are possible for Medicaid?

Right now, both President Trump and House Speaker Paul Ryan have called for block granting Medicaid. That means that a set sum of money would be allocated to states within a period of time, and the state would have more control over those funds. The idea of block grants has been around for about 30 years. They are attractive because there are fewer federal rules to comply with and the states can use the money however they wish. But block grants shift more costs onto the states, and governors tend to oppose that.

Another idea floating around is a per capita cap, which would give the states a fixed dollar amount per individual, based on Medicaid standard lines (the blind, aged, and disabled children and adults). A per capita cap may force the states to control Medicaid costs over time, but there is also a demographic shift to consider—the medical needs and costs for an 85-year-old are much greater than for a 65-year-old. Nursing homes and aging disability provider groups have a huge stake in this and would likely oppose it, as would some governors.

The cost changes may not be felt right away, but they will be noticeable ten years from now and that’s what Congress must plan for. There may be increased waiver flexibility for the states and provider taxes to offset states’ losses. We may also see reforms to make it easier to manage care.

What can I do?

The best course of action for you is to keep yourself informed of the potential changes to Medicaid and Medicare. Read arguments from both sides of the issue and consider how they will affect you, your family, your community, and the country at large. Be aware of your local political leaders and representatives, and what their positions are. And let them know your position! An essential part of democracy is to let your voice be heard on these issues. Your representatives do want to know what you think.