Donald Trump and members of his administration have been working for months on a secret plan to cutback the Medicaid program, which provides healthcare and nursing home benefits for the poor and elderly.
They have been working on the plan in secret because they want to bypass Congress and give block grants to states for Medicaid. Instead of the traditional open-ended entitlement, which increases costs, states would get set Medicaid spending limits.
In addition, the Trump approach would allow states more leeway to run the low-income health program the way they want to, even if outside of federal rules.
The Medicaid program provides health and nursing home benefits to almost 75 million Americans, including poor children, disabled people, and impoverished senior citizens who require nursing care.
The Trump administration approach of using block grants has been a Republican dream since Ronald Reagan’s presidency. It would reduce costs but also reduce the health safety net for the country’s poorest and most vulnerable citizens.
Putting in Medicaid spending caps would mean fewer low-income people getting covered, lower benefits for people who are covered, and state-designated cutbacks in health benefits for Medicaid recipients.
For several months the Trump administration has been creating guidelines for the new program which would be a major overhaul of Medicaid in affected states.
Republicans maintain that block grants would allow states to spend Medicaid money smarter with few federal strings attached. The federal guidelines require minimum benefits and for certain things to be covered that conservatives want to eliminate in order to save taxpayer dollars.
There is great political sensitivity around what the administration is doing, and the approach has been unsuccessfully proposed in Congress for decades. It has never been approved because of very strong opposition from Democrats and patient advocates.
What Trump and the Republicans want to do has always been very unpopular. For example, during the debate over repealing Obamacare in 2017, GOP proposals to cap and shrink federal Medicaid spending galvanized public opinion against repeal of the increasingly popular healthcare law.
Progressive health groups published projections showing that the Republican plan would force millions of vulnerable people off health coverage.
Trump’s plan will face many legal and political obstacles, however. There is no guarantee their plan to bypass Congress will work. And now that Democrats are in control of the House, there is zero chance that the plan would be approved there.
According to POLITICO:
“The administration’s plan remains a work in progress, and sources said the scope is still unclear. It’s not yet known whether CMS would encourage states to seek strict block grants or softer spending caps, or if new limits could apply to all Medicaid populations — including nursing home patients — or just a smaller subset like working-age adults.”
CMS stand for Centers for Medicare and Medicaid Services, the federal agency charged with administering the federal health programs.
Some people will be shocked that, while tens of millions of Americans still lack healthcare coverage, and the popularity of “Medicare for All” proposals is increasing, Trump and Republicans in Washington are actually trying to take away life-saving benefits from the poor, elderly and disable.
This is just one more example of how far removed Donald Trump is from the daily reality of life for the average American. It also shows once again that the Republican Party cares only about its wealthy constituents who want government to do nothing but lower their taxes.
I am a lifelong Democrat with a passion for social justice and progressive issues. I have degrees in writing, economics and law from the University of Iowa.