Replace?

Gov. Romney gives a speech describing his approach to replacing the ACA. Quite a non serious speech from someone who knows quite a lot about health policy. Maybe he is pacing himself.

His clearest notion seems to be giving states flexibility via block granting of Medicaid to expand coverage.

Just keep in mind when you hear someone say block granting of Medicaid is a key part of a plan to expand coverage to uninsured folks that the big money in Medicaid now goes to the elderly, and disabled (mostly due to paying for Long Term Care).

If you block grant Medicaid and grow the block granted amount slower than health care inflation, it will be very hard (impossible) to provide similar services to the existing beneficiaries. With block granting, you either can’t expand coverage or you have to cut benefits and services, and most of the cuts will have to fall on the elderly and disabled. Most folks forget that Medicaid is at least 3 programs.

Block granting Medicaid is not a strategy to expand insurance coverage, unless it is combined with a plan to severely reduce long term care spending paid for by Medicaid for the elderly and disabled, or you are planning to spend more money via a block granted approach than is currently projected for Medicaid.

(cross posted at freeforall)

Author: Don Taylor

Don Taylor is an Associate Professor of Public Policy at Duke University, where his teaching and research focuses on health policy, with a focus on Medicare generally, and on hospice and palliative care, specifically. He increasingly works at the intersection of health policy and the federal budget. Past research topics have included health workforce and the economics of smoking. He began blogging in June 2009 and wrote columns on health reform for the Raleigh, (N.C.) News and Observer. He blogged at The Incidental Economist from March 2011 to March 2012. He is the author of a book, Balancing the Budget is a Progressive Priority that will be published by Springer in May 2012.

4 thoughts on “Replace?”

  1. Block granting Medicaid is not a strategy to expand insurance coverage, unless it is combined with a plan to severely reduce long term care spending paid for by Medicaid for the elderly and disabled…

    So which of the major corporate networks do you suppose will begin questioning Romney and his plan with that as a preface?

    Which is not to suggest that I don’t love your posts Don.
    Only that in a country where half the folks don’t even know the VP’s name…
    Well, Romney can pretty much saw whatever he pleases as loudly as he pleases.

  2. Almost any time you hear “block grant” you know someone is trying to destroy the programs that are part of the block grant. It’s way too easy to cut the top-line number without thinking about how various subprograms will be affected. And all the constituencies for those subprograms end up pitted against one another, because in the short run there’s always more incentive to go for a larger slice of the (shrinking) pie than to work with everybody else to get a larger pie.

    You’ll notice that pretty much all the sacrosanct expenditures get budgeted the opposite way: the amount per project or recipient gets set, and then all those amounts get added up to yield a total figure. Imagine if we just set a total budget for yearly social security outlays, and let individual retirees fight it out with their sate-level SSA administrators and one another. Or if we set a cap for the DoD and let each military command use whatever means it thought necessary to get the funds it wanted…

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