With Trump's victory, GOP hopes to overhaul Medicaid

[webfact]

With Trump's victory, GOP hopes to overhaul Medicaid

By CHRISTINA A. CASSIDY

 

ATLANTA (AP) — When President-elect Donald Trump takes office in January, Republicans will have the opportunity to pull off something they have wanted to do for years — overhaul Medicaid, the program that provides health care to tens of millions of lower-income and disabled Americans.

 

Any changes to the $500 billion-plus program hold enormous consequences not only for recipients but also for the states, which share in the cost.

 

Trump initially said during the presidential campaign that he would not cut Medicaid, but later expressed support for an idea pushed for years by Republicans in Congress — sending a fixed amount of money each year to the states in the form of block grants. Backers say such a change in the Medicaid formula is one of the best ways to rein in spending, but critics say big cuts would follow.

 

Currently, the federal government pays an agreed-upon percentage of each state's Medicaid costs, no matter how much they rise in any given year.

 

Republicans have argued that states have little incentive to keep expenses under control, because no state pays more than half the total cost. Both House Speaker Paul Ryan and Trump's pick for secretary of health and human services, Georgia Rep. Tom Price, want to switch to block grants.

 

Key questions facing Republicans will be how the funding is structured and how much flexibility will be given to the states.

 

"It's exciting because you know it's not going to be the same as it was, and it's nerve-wracking because you know it's not going to be the same as it was," said Terry England, a Republican state lawmaker who chairs the House budget committee in Georgia.

 

Republican control of Congress and the presidency means the GOP can act on its long-held priorities of reining in entitlement programs and repealing President Barack Obama's health care law, which allowed states to expand the number of people eligible for Medicaid. Thirty-one states have opted for the expansion.

 

It is not clear what the GOP's replacement plan will look like. Democrats have warned of dire consequences, and any proposed changes are likely to trigger a fight in Congress.

 

Last week, the Democratic Governors Association warned that repealing the Affordable Care Act would end health coverage for millions of people and shift the financial burden onto the states, costing them $68.5 billion in uncompensated care over the next decade. The group said the Medicaid expansion alone has provided coverage for millions of Americans who lacked insurance and that it had been a critical tool for states in combating the opioid epidemic.

 

In 2012, a plan by Ryan to reduce the federal deficit included a proposal to convert Medicaid funding into block grants with a cap on the amount the federal government would provide. Advocacy groups warned that that approach would ultimately lead to fewer people receiving coverage.

 

The Congressional Budget Office concluded that under Ryan's proposal, "states would need to increase their spending on these programs, make considerable cutbacks in them, or both."

 

Earlier this year, Ryan and Republican leaders offered another, more flexible option: States would receive a fixed amount from Washington for each person enrolled. That approach would allow federal payments to grow if, for example, a recession forced more people onto Medicaid.

 

More than 70 million are on Medicaid, nearly 10 million of them covered as a result of the expansion.

 

GOP budget documents say federal spending on Medicaid has increased 200 percent in the past 15 years, and the Congressional Budget Office projects it will climb 68 percent over the next decade to $642 billion. In addition, total state spending on Medicaid is expected to rise from about $216 billion in fiscal year 2015 to more than $337 billion in 2023.

 

How the GOP overhaul is ultimately structured will be critical, said Matt Salo, executive director of the National Association of Medicaid Directors.

 

"Some of my members are looking at this and saying if this isn't done right, if the money doesn't match what needs to be done, this is potentially the greatest intergovernmental transfer of financial risk in the country's history," he said.

 

States, many of them struggling with budget shortfalls, could end up covering fewer procedures or medications, instituting work requirements or requiring co-pays or premiums. Those that opted to expand Medicaid could decide it's no longer sustainable.

 

Among those now covered because of the expansion is 59-year-old Alan Purser of Wynne, Arkansas, who tapped into the program after losing his job in 2014 when the pawnshop where he worked was sold.

 

A few weeks after signing up, he went to the doctor because of a bad cough. He was diagnosed with blood clots in both lungs and ended up in the hospital for 10 days.

 

"Honestly, I would be dead without this coverage," said Purser, who is on disability. "I never would have gone to the doctor without insurance."

 

Purser said he fears having his benefits reduced.

 

"When you live on $730 a month," he said, "you have to watch where everything goes, and you just can't start paying more and more for your medicines."

 

-- © Associated Press 2016-12-30

[craigt3365]

Best of luck.  Medicare desperately needs an overhaul.

[bgrassboy]

30 minutes ago, craigt3365 said:

Best of luck.  Medicare desperately needs an overhaul.

Lol Craig "Medicaid",  not Medicare ? 

[maewang99]

March 2017 looms.  a new debt ceiling above a cool 20 trillion US dollars.  the 2015 Bipartisan Budget deal expires in March and Medicaid spending is accelerating because of demographics, as inexorable as Co2 [ ha!!!! I got that in there.... unless the web police delete my post! ] 

[craigt3365]

15 minutes ago, bgrassboy said:

Lol Craig "Medicaid",  not Medicare ? 

5555  First cup of coffee!  Perhaps both need to be overhauled! LOL

[Pib]

Me thinks Donald and the Republican Congress will run into a buzz-saw in their attempt to significantly modify Medicaid (or Medicare), especially the part about block grants and more control going back to the states.   Will they make some small changes....sure.  And they will hype these small changes in trying to make them earth shaking.  

 

But they will only have about a year to do this because with politicians being politicians when they get within approx a year before the next mid term elections in Nov 2018 for congressional seats they will lay low again in an attempt not to do anything that pisses off too many voters.   And Medicaid (and Medicare) beneficiaries and their family members compose a LOT of voters.

[Dustdevil]

Medicaid is one thing. A lot of poor  hillbillies (many are welfare cheats who sit around moaning about minorities getting welfare) voted against their own interests. It will be easy to reduce Medicaid benefits, because the recipients who use it are poor and powerless unless they have a powerful Democrat congressman/woman and senator. It's Medicare they won't be able to curtail --because they'll run into a firestorm of tens of millions of senior citizens.  AARP is as powerful as the gun lobby. The Mitch McConnells  can bitch all they want but they won't be able to privatize or dismantle Medicare.

[Pib]

Your post makes it sound like only poor hillbillies from certain sections of the country are on Medicaid.  If you believe that, time to expand your knowledge a little bit by looking at some statistics of who and the location of the 70 or so million beneficiaries.  Start with below Kaiser websiite:

http://kff.org/state-category/medicaid-chip/medicaid-beneficiaries/

[sawadeeken]

OH........... GOOD NEWS....................................

Let's wait to see................................

[Mansell]

The Republicans will also be trying to cut Social Security and Medicare....Why? Because they don't have to use these things as they get huge pensions and guaranteed healthcare. They try to say it is entitlements.....Social Security we paid into for a minimum of three decades to be ENTITLED to our own money. The Republicans are a bunch of hypocrites and spongers sucking at the public teat. All of us here recieving Social Security be very careful as those Washington PIGS will take it all away from you if you are not paying attention. They want to create generations of Americans living in poverty while they scream about burning the flag. F#+k them.

next week I will tell you how I really feel....555

Edited December 30, 2016 by Mansell

[Jingthing]

War on the poor. It's the republican way. 

 

[lannarebirth]

Given the demographics and the demographics to come, what a smart legislature would do is shitcan Obamacare, reduce the age for receiving Medicare by one year for each of the next ten years, and leave Medicaid just as it is. This is the simplest way to work into a Universal healthcare program. The working middle class wills see, rightfully, that they are being screwed and will in the end join the universal system rather than fight it.

[Pib]

Maybe you mean increase the age of Medicare by one year....like changing it from 65 to 66?   Reducing would mean lowering it to 64 putting even more people on Medicare which would increase its cost.  

 

A Universal health care program needs to cover everyone, of any age group 1 day old to till you die hopefully at a ripe old age; cover low, middle and high income people even if they could afford their own health insurance; cover preexisting conditions, etc.  

 

Although I still hopefully have decades of life ahead of me I'm not holding my breath the U.S. will have universal health care during my lifetime; instead, it will continue on with a patchwork of separate govt and private medical coverage programs.  

 

But I do think there is now a definite trend to get the "uninsured" covered in some fashion under a govt or private medical plan...and forced coverage if necessary.

[Pib]

20M on Medicare.   There is over 50M.

 

I beginning to think many people just don't understand that Medicaid and Medicare are two different programs focusing on various groups and income levels.

 

Edited December 30, 2016 by Pib

[Pib]

https://www.medicareinteractive.org/get-answers/introduction-to-medicare/explaining-medicare/what-is-the-difference-between-medicare-and-medicaid

 

What is the difference between Medicare and Medicaid?

Medicare and Medicaid are two different government-run programs that were created in 1965 in response to the inability of older and low-income Americans to buy private health insurance. They were part of President Lyndon Johnson’s “Great Society” vision of a general social commitment to meeting individual health care needs. Medicare and Medicaid are social insurance programs that allow the financial burdens of illness to be shared among healthy and sick individuals, and affluent and low-income families.

Medicaid is not the same as Medicare.

• Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income.
• Medicaid is a state and federal program that provides health coverage if you have a very low income.
• If you are eligible for both Medicare and Medicaid (dual eligible), you can have both. Medicare and Medicaid will work together to provide you with very good health coverage.

Edited December 30, 2016 by Pib

[jcsmith]

7 hours ago, Mansell said:

The Republicans will also be trying to cut Social Security and Medicare....Why? Because they don't have to use these things as they get huge pensions and guaranteed healthcare. They try to say it is entitlements.....Social Security we paid into for a minimum of three decades to be ENTITLED to our own money. The Republicans are a bunch of hypocrites and spongers sucking at the public teat. All of us here recieving Social Security be very careful as those Washington PIGS will take it all away from you if you are not paying attention. They want to create generations of Americans living in poverty while they scream about burning the flag. F#+k them.

next week I will tell you how I really feel....555

 

Isn't it great that the wealthiest Americans are getting a 13% reduction in taxes while everyone else gets to deal with this?

[WaywardWind]

10 hours ago, Pib said:

Your post makes it sound like only poor hillbillies from certain sections of the country are on Medicaid.  If you believe that, time to expand your knowledge a little bit by looking at some statistics of who and the location of the 70 or so million beneficiaries.  Start with below Kaiser websiite:

http://kff.org/state-category/medicaid-chip/medicaid-beneficiaries/

Exactly.  As significant number of Medicaid (and Medicare for that matter) recipients are elderly and need full institutional care.

 

Annual spending on long-term care in the United States–excluding unpaid family caregiving–has reached nearly $275 billion. Who is paying?–47% is Medicaid, 23% is Medicare, 23% by Families out-of-pocket expenses, less than 4% by Veterans/State programs and less than 3% is private long-term care insurance.

https://www.phca.org/for-consumers/research-data/long-term-and-post-acute-care-trends-and-statistics

 

[rabas]

13 hours ago, maewang99 said:

March 2017 looms.  a new debt ceiling above a cool 20 trillion US dollars.  the 2015 Bipartisan Budget deal expires in March and Medicaid spending is accelerating because of demographics, as inexorable as Co2 [ ha!!!! I got that in there.... unless the web police delete my post! ] 

 as inexorable as Co2 [ ha!!!! I got that in there....

 

Lol, threatens us with di-atomic Cobalt metal,  Co2 ...... I for one am not scared.

Edited December 30, 2016 by rabas

[au82tiger]

It always amazes me how the pundits on the left always come up with what is going to happen, when they have absolutely no idea and have no input.  Let the President Elect take office and watch the first few months and actually see what he and his people will try to do.  If he does something you don't like and something you feel is wrong vote for the other guy/woman and take your feelings to the polls, and try to get the change that you want.  Stop throwing "BS" ... it means nothing! 

[Jingthing]

14 minutes ago, au82tiger said:

It always amazes me how the pundits on the left always come up with what is going to happen, when they have absolutely no idea and have no input.  Let the President Elect take office and watch the first few months and actually see what he and his people will try to do.  If he does something you don't like and something you feel is wrong vote for the other guy/woman and take your feelings to the polls, and try to get the change that you want.  Stop throwing "BS" ... it means nothing! 

We can resist negative changes before they happen as much as possible. Ripping away life saving health care from poor and sick people is what's being threatened and that's most likely what they're going to accomplish. If that doesn't concern you ... color me NOT amazed. Right wingers generally don't really care about such issues. 

 

Also, being a citizen is not only about elections. If citizens don't pay attention after elections, those in power can get away with anything they want, and they usually do. This time, we've got a populist demagogue con man in power ... he will do a massive amount of damage ... there are millions of people working to minimize that damage with the hope there is something left after the horror reality show president finally finishes his big show. 

 

This isn't a normal situation or a normal president. The level to which trump is unfit to be president is mind boggling. Many get that ... you obviously don't. 

Edited December 30, 2016 by Jingthing

[ilostmypassword]

7 hours ago, au82tiger said:

It always amazes me how the pundits on the left always come up with what is going to happen, when they have absolutely no idea and have no input.  Let the President Elect take office and watch the first few months and actually see what he and his people will try to do.  If he does something you don't like and something you feel is wrong vote for the other guy/woman and take your feelings to the polls, and try to get the change that you want.  Stop throwing "BS" ... it means nothing! 

Really? People have no idea what he's going to do?  So, it's just an amazing coincidence that the chose the most right wing cabinet ever?  He could just have easily chosen Noam Chomsky to be his Secretary of State?  We have a pretty good idea of where he's going.  And it's best to start alerting people now so they can let their congressional representatives know what is and is not acceptable.

[impulse]

Whenever I read GOP and "overhaul" in the same sentence, it usually means making it more expensive for everyone but government employees and big corporations.

 

Edited December 31, 2016 by impulse

[Mansell]

After living in the U.S. for 43 years my experience of the Republicans is pretty plain and simple. They spend all their time out of office waving the U.S. flag and quoting the Constitution, and doing their best to undermine whomever is president. Then they get in office and start trying to erode the Constitution while waving the flag. I defy anybody on here to name the last good Republican president who did good things for the country? And don't throw up Reagan as he was a lousy president, along with Bush 1 and Bush 2, Nixon, his Vice. Also check out how many Republicans have been indicted for corruption over the last twenty years. So I will take the left any time.

[Scott]

3 minutes ago, Mansell said:

After living in the U.S. for 43 years my experience of the Republicans is pretty plain and simple. They spend all their time out of office waving the U.S. flag and quoting the Constitution, and doing their best to undermine whomever is president. Then they get in office and start trying to erode the Constitution while waving the flag. I defy anybody on here to name the last good Republican president who did good things for the country? And don't throw up Reagan as he was a lousy president, along with Bush 1 and Bush 2, Nixon, his Vice. Also check out how many Republicans have been indicted for corruption over the last twenty years. So I will take the left any time.

Lincoln?

[Gary A]

Medicaid should not be part of Social Security. It belongs in the welfare category. Medicare and Social Security were paid for by working people who planned to collect money and medical care after they retire. Social Security will eventually go broke but welfare will NEVER go broke. Get rid of the corrupt leeches on benefits would also help a lot.

[rabas]

2 hours ago, Mansell said:

After living in the U.S. for 43 years my experience of the Republicans is pretty plain and simple. They spend all their time out of office waving the U.S. flag and quoting the Constitution, and doing their best to undermine whomever is president. Then they get in office and start trying to erode the Constitution while waving the flag. I defy anybody on here to name the last good Republican president who did good things for the country? And don't throw up Reagan as he was a lousy president, along with Bush 1 and Bush 2, Nixon, his Vice. Also check out how many Republicans have been indicted for corruption over the last twenty years. So I will take the left any time.

 

List of American federal politicians convicted of crimes

https://en.wikipedia.org/wiki/List_of_American_federal_politicians_convicted_of_crimes

Numbers are pretty equal, but Clinton's administration could be a winner.

[rabas]

3 hours ago, Mansell said:

After living in the U.S. for 43 years my experience of the Republicans is pretty plain and simple. They spend all their time out of office waving the U.S. flag and quoting the Constitution, and doing their best to undermine whomever is president. Then they get in office and start trying to erode the Constitution while waving the flag. I defy anybody on here to name the last good Republican president who did good things for the country? And don't throw up Reagan as he was a lousy president, along with Bush 1 and Bush 2, Nixon, his Vice. Also check out how many Republicans have been indicted for corruption over the last twenty years. So I will take the left any time.

 

John Fitzgerald Kennedy!

 

By today's standard's of liberalism and elitism, Kennedy was conservative, caring greatly for his country.  Lyndon Baines Johnson was who broke ground to build the swamp they all, D&R swim in today.

It's not D and R, it's them.....

[Usernames]

First thing to do? Forbid non-citizens from receiving Social Security.

[Scott]

7 hours ago, Usernames said:

First thing to do? Forbid non-citizens from receiving Social Security.

You can't really force people to pay into the program if you are going to deny them the right to collect.   To collect SS a person has to work a fairly long period of time, so it's not easy to collect without having been in the US for an extended period of time.  

 

But this thread is about Medicaid and that is a different program.  

[Usernames]

2 minutes ago, Scott said:

You can't really force people to pay into the program if you are going to deny them the right to collect. 

 

Why not? Thailand has forced me to do so.  Germany forced me to do so.  And, as a foreign national, I can't collect anything from either country.