Senate Republicans Look to States on Future of Medicaid

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By Victoria Pelham

Dec. 13 — Senate Republicans are looking to Republican governors for input on the future of Medicaid, as the form federal spending will take on it in the incoming Trump administration hangs in the balance.

Senate Finance Committee members, spearheaded by Sen. Orrin Hatch (R-Utah), wrote in a Dec. 13 letter to the Republican Governors Association that they were planning a January roundtable with governors on the public insurance program, noting the plausibility of an Affordable Care Act repeal.

The push from Finance Committee members comes a week after Senate Democrats banded together to send their own message to President-elect Donald Trump—don’t gut entitlements—and a day after acting CMS Administrator Andy Slavitt warned against funding the $550 billion Medicaid program through block grants, saying it wouldn’t improve flexibility.

“Even before the most recent expansion resulting from the Affordable Care Act, the Medicaid program was plagued by quality issues, states were stymied in their attempts to utilize innovative solutions to improve patient care, and both federal and state Medicaid spending was growing at unprecedented, and unsustainable levels,” the Republican senators said.

Medicaid grew 3.8 percent in 2015, according to the latest figures from the Centers for Medicare & Medicaid Services, a slower amount than the previous year.

What Might Change

The senators are asking states for feedback on how to better partner together, promote the ability to tailor funds for their different beneficiary populations, control spending and spur new ideas in Medicaid delivery systems. They are also looking at viable Obamacare alternatives and ways to protect the health care of those covered under ACA-expanded Medicaid (whose incomes are up to 138 percent of the federal poverty level).

Sen. Bill Cassidy (R-La.), who is also a doctor, told a Dec. 12 Washington Post health-care discussion that Medicaid coverage did not always equate to health-care access, pointing to high numbers of emergency room visits and the amount of the Medicaid dollar that goes directly to the patient.

“Medicaid does not work well; it’s very expensive for the taxpayer, and we can do better,” he said.

The Senate Republicans’ calls fall in line with President-elect Trump’s push for state flexibility on Medicaid, with many analysts saying the program might be converted to block grants or per capita payment caps. These would limit the amount of federal money going to state Medicaid and also allow the states to impose their own requirements. Some have also suggested they would have a net effect of cutting benefits and, together with measures such as work requirements, moving the program back to temporary, safety-net coverage.

But Slavitt said at the same Dec. 12 event that block grants—the “big question” right now—were initially floated in a climate before there were existing cost controls and essential benefits. In today’s world of Medicaid managed care plans, that proposed policy would actually mean less flexibility, he said.

Medicaid block grants “are something we all ought to be very, very deeply focused on and to my mind all very, very deeply concerned about,” Slavitt said.

To contact the reporter on this story: Victoria Pelham in Washington at

To contact the editor responsible for this story: Brian Broderick at

For More Information

The letter is at

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