Republicans talk a lot about how Medicaid block grants could help governors bring down their costs, but they don’t talk as much about what, exactly, the states would do with them.
It’s not that they have no answers. Gov. Haley Barbour of Mississippi has said he’d like to provide home-based care for children with special medical needs, rather than resort to more expensive hospital care, but federal rules get in the way. And a prominent conservative think tank says states could invest in money-saving systems if they had more funds upfront.
But those changes most likely would get them only partly to the kind of savings Rep. Paul Ryan has proposed in his budget. And the other kinds of changes Republicans are eying are harder to talk about: stricter eligibility rules, benefit cuts, higher copayments for people with low incomes and lower payments to providers who already think Medicaid doesn’t pay them enough.
In an analysis of the Ryan budget proposal, the Congressional Budget Office said governors would have to “reduce payments to providers, curtail eligibility for Medicaid, provide less extensive coverage to beneficiaries or pay more themselves” to produce the $771 billion in federal savings Ryan wants over 10 years.
A spokesman for Ryan wouldn’t comment on the CBO analysis but pointed to Tuesday’s letter to Ryan from four Republican governors — Republican Governors Association Chairman Rick Perry of Texas, Vice Chairman Bob McDonnell of Virginia, Barbour and Gov. Chris Christie of New Jersey — calling Medicaid “an antiquated, federal maze of regulations and mandates” requiring “months and sometimes years of negotiations for even modest changes.”
Democrats describe the future of Medicaid block grants in the worst terms — and take aim at Barbour, a likely presidential candidate and one of the most vocal advocates for the idea.
“Haley Barbour wants to cut services. He wants to throw people off Medicaid, particularly children,” and cut provider reimbursement rates “so people can’t get services,” said Rep. Frank Pallone (D-N.J.).
Not true, said Barbour spokeswoman Laura Hipp: “Hyperbolic political rhetoric never solved a problem, and that certainly applies to addressing the significant funding shortfalls Medicaid currently faces. Gov. Barbour wants states to have the ability to quickly implement innovative programs that enhance health care for children and adults while not bankrupting states.”