Mediciad Block Grants Are Not Good For Seniors
While the fate of Medicare has drawn the most attention during the election
campaign, some seniors and their families may have even more at stake in the
debate over Medicaid.
Support from Medicaid plays a much less visible but nevertheless essential
role as the safety net for middle-class Americans whose needs for long-term
care – at home or in a nursing home – outlast their resources. With baby
boomers and their parents living longer than ever, fewer families can count on
their own savings to go the distance.
Maryland citizens who currently rely on Medicaid are diverse. Most people
think about Medicaid as solely a program for low-income children and families, but
this is not the case.
The ACA, which was signed into law in March of 2010, includes an expansion
of Medicaid to beneficiaries with income up to 133% of the federal poverty
level. However, since Medicaid is funded by both the federal and state
governments, the U.S. Supreme Court ruled that this expansion of Medicaid would
be optional rather than mandatory. The federal government would pay 100% of the
expansion costs between 2014 and 2017 for the newly eligible people who would
enroll, with the state beginning to contribute to these costs beginning in
2018, increasing to and never exceeding a limit of 10% in 2020.
Former Massachusetts Gov. Mitt Romney, the Republican candidate, would move
Medicaid in the opposite direction. He would repeal the ACA and would replace
the current Medicaid program with block grants, giving each state a lump sum
and letting them decide eligibility and benefits. (Currently, the federal
government sets minimum requirements, such as covering all children under the
poverty level). The grants would grow at the rate of inflation, with
adjustments for population growth.
It is unclear how the federal government would determine the initial amount
of each state's block grant and it is likely that annual increases would not
keep up with rising health care costs. Thus, it is inevitable that the block
grant plan would shrink the medical safety net for the poorest Americans. The
Urban Institute, a nonpartisan research group, estimated that under a similar
House budget proposal last year, 14 million to 27 million people would lose
Medicaid coverage by 2021.
We contend that the planned Medicaid expansion under the ACA is good for Maryland
children, families, the disabled and seniors who cannot afford the costs of
The profound effect of Romney's proposed Medicaid policy, including state
block grants, on Medicaid patients must be recognized and debated. Hopefully,
future discussions will focus upon specific Medicaid policies which could
improve health care outcomes and reduce costs, rather than harming
beneficiaries by decreasing access to coverage.
We need to support the policies in the ACA that focus on improving health
care quality and reducing cost, and look for new and innovative ways to promote
long and healthy lives for all. The goal of high quality affordable health care
for everyone in Maryland is achievable when our elected officials and health
care leaders work together.