While I often disagree with policy positions articulated by Gov. Bruce Rauner, I had to agree with him when he spoke out against the current effort to convert Medicaid into a Block Grant being pushed by Republicans in an attempt to derail the Affordable Care Act.
One of the most important provisions of the ACA was giving the states the option of expanding the number of low-income individuals who could qualify for Medicaid coverage. Many of these individuals are people working in the service sector or construction who don’t get employment-based health insurance and cannot afford private insurance. Medicaid currently covers about 72 million people nationally (3 million in Illinois).
Thirty-one states utilized this option to expand the number of individuals who are covered by Medicaid and 16 of them have Republican governors. Now many of them are worried that the ACA repeal effort by the U.S. Congress will have a devastating impact on both the health of the people they serve and the health of their state budgets. Each of us should be worried as well.
Enacted in 1965, Medicaid is a federal program that assisted the poor who were aged, blind and disabled to access a minimum standard of health care throughout the nation. The program also required health-care benefits to be provided to families who qualified for the Aid to Families with Dependent Children program as well as women (including pregnant women) and their children whose household income did not exceed 133 percent of the federal poverty level.
Each state has a strong role in defining how much money they will put into the program and what services will be covered. The federal government specifies basic health services that must be covered and then agrees to match the state tax dollars that are placed in the program based on a formula derived from the state’s average individual income. It varies from a 50-50 match in richer states to a maximum possible 83-17 federal-state match.
States can then decide to put further funds into Medicaid and expand either the health services that can be provided or expand eligibility. The reality is that each state has a different Medicaid program – what and who is covered in Illinois is different from what is done in South Carolina. Each state administers its own Medicaid program.
The ACA made it possible for states to elect to expand Medicaid benefits so that many of the working poor had health insurance for the first time.
So now we come to the problem as a Republican Congress sees it. States have had the freedom to drive how much the federal government puts into Medicaid based on what the states put into it.
The
Republican plan is to give each state a choice. One is to take a fixed
dollar allotment for every person enrolled in Medicaid (per capita
allotment). The feds will determine how much that allotment will be, but
it is likely that it will be enough to provide only a reduced part of
the cost for basic health services. The other option is for the state to
accept a block grant (an annual lump sum) that will be calculated based
on the assumption that the state will drop people who were covered via
the ACA Medicaid expansion.
In
either case the Republicans in Congress like the fact that this will
provide them with budgetary certainty, since the federal government will
no longer have to proportionally match the money that states put into
funding health care for the less fortunate.
With
either option, states will be faced with the need to drop people from
healthcare coverage or cut the services covered or increase state
spending to compensate. Given a huge state deficit and a budget
stalemate, the potential for the Medicaid system in Illinois to collapse
under the proposed federal Republican Medicaid reforms is real and with
that the health status of one in five Illinoisans could collapse as
well.
Thus it is
imperative that citizens make their concerns regarding these Medicaid
reform proposals known to Republican U.S. Representatives Darin LaHood
and Rodney Davis, Democratic U.S. Senators Dick Durbin and Tammy
Duckworth as well as President Trump in the next few weeks. For the
health of our citizens and the health of our state budget, Illinoisans
need to make their voices heard now.
Dr. Soltys is a retired professor emeritus who still teaches on a volunteer basis at SIU School of Medicine.
