If Republicans win both the White House and Congress this fall, it could mean drastic changes to the Medicaid program as Americans have known it for decades. What started as a way to deliver health insurance to the poor, disabled and elderly under President Lyndon Johnson has now become a political lightning rod for Democrats and Republicans.
Conservative activists are pushing Congress to transform Medicaid into a block-grant program, a plan which draws support from GOP candidate Mitt Romney. In this scenario, Medicaid would cease being a federal program, and power for determining fund allocation, program design and eligibility for services would fall to the states themselves. All told, such a change would reduce federal spending on Medicaid by $1.5 trillion in ten years.
Conservatives have longed for such a shift in policy for decades, but even some members of the Republican Party are wary that states would be unable to come up with the amount of money needed to deal with a population which is not going to significantly decrease in size. Democrats and healthcare providers point out that slashing Medicaid will only result in a massive increase in the uninsured. Meanwhile, a recent Kaiser Family Foundation poll found that 67 percent of Americans support a Medicaid expansion under the Affordable Care Act.
Does the Republican plan have any real legs? If so, what would it mean for individual states, particularly California? How would you see your own coverage change under a block-grant program?
Gerald F. Kominski, Ph.D., Professor, Department of Health Services, UCLA Fielding School of Public Health; Director, UCLA Center for Health Policy Research
Dustin Corcoran, CEO of the California Medical Association