Health Care Questions: What are "Medicaid caps?"

This week, the NCC Blog is attempting to answer some basic questions about the current health care debate, especially as it relates to people with disabilities.

Read the posts so far:

What's going on? And why?
What's the deal with "Pre-Existing Conditions?"
What's the argument over the "Medicaid Expansion?"

Today's question is ...

What are "Medicaid caps?"

• Medicaid is a federal entitlement. If you fit the criteria to qualify, and you sign up, then you can get whatever health care services you need. This may be limited by what your state will and won't cover, and what your doctors think you need, but it's never limited by a federal budget or how much health care other Medicaid recipients need. The amount the federal government spends on Medicaid depends entirely on how much health care Medicaid recipients need.

• One of the core elements of the American Health Care Act, (AHCA, a.k.a.: Obamacare), is to fundamentally change how Medicaid is funded, by capping the amount of money the federal government will give to each state for Medicaid each year. Formulas for this vary, but what's been proposed so far would not only limit Medicaid, but significantly reduce it, by over $880 billion over ten years.

• If federal Medicaid is capped, then each state would get a set amount of Medicaid funding each year. If needs are less than that, then fine. If they are more, then states wold have to figure out how to pay for them.

• This would create enormous pressure on states to cut back on services considered "extra" or "nonessential," like home care, community supports, physical therapies, etc. You can't subtract over $880 billion from Medicaid and expect no reduction in services. Waste, fraud, and abuse is at most a tiny fraction of that.

• In addition, the proposals so far would intentionally formulate the Medicaid caps to bring about substantial reductions in Medicaid into the future ... over $880 million over the next 10 years. The Republican's Senate bill might extend that time period a bit, or slightly reduce the cut, but the fundamental hit will remain.

• Limiting and cutting Medicaid ... and shifting more responsibility for it to the states ... would not be an unintentional side effect. Medicaid cuts and limitation are core goals of Republican health care policy.

Tomorrow we'll look at the affect Medicaid caps and cuts would have on the lives of people with disabilities.

The Senate Has a New Idea to Cut Medicaid That’s Even Crueler Than the House Plan
Jordan Weissmann, Slate.com - June 19, 2017

Medicaid works -- let's keep it that way
David Perry, CNN - June 20, 2017

The disabled will pay for the GOP’s Medicaid cuts
Julie Reiskin, The Hill - June 21, 2017

Republicans’ Obamacare repeal would be one of the biggest cuts to the social safety net in history
Max Ehrenfreund, Washington Post Wonkblog - June 22, 2017