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Excerpt: "Republican governors are working with the Trump administration to do something Congress couldn't accomplish: fundamentally alter their state Medicaid programs."

A doctor administers a vaccine to her patient. (photo: Getty)
A doctor administers a vaccine to her patient. (photo: Getty)

GOP Governors Are Quietly Working With Trump to Cut Medicaid

By Nathaniel Weixel and Rachel Roubein, The Hill

03 August 17


epublican governors are working with the Trump administration to do something Congress couldn’t accomplish: fundamentally alter their state Medicaid programs.

At least six states with GOP governors— Arkansas, Kentucky, Arizona, Maine, Wisconsin and Indiana — have already drafted plans meant to introduce new rules people would have to meet to be eligible for Medicaid, which provides healthcare to low-income Americans and those with certain disabilities.

Some want to add work requirements or introduce drug testing for recipients. Others want to raise premium prices.

The Trump administration has to approve the plans. Some approvals could come in weeks.

Critics say the proposed changes will leave fewer people on Medicaid and hurt the poor and vulnerable.

“There are limits on what's allowable, and tying eligibility to work or drug testing or some of these other things is not consistent with what should be allowed,” said Judith Solomon, vice president for health policy at the liberal-leaning Centers on Budget and Policy Priorities.

“That said, we know we now have an administration that likely thinks differently, and we could see some changes in that regard,” she said.

Proponents argue the changes, which would waive federal requirements under Medicaid, are an important tool in trimming the fast-rising costs of the program.

They say Medicaid recipients should have some “skin in the game” — an incentive to transition from government support to full-time employment.

“Medicaid is Pac-Manning state budgets right now. It’s taking money away from education, transportation, in expansion and non-expansion states alike. It is eating their budgets,” said Josh Archambault, a senior fellow at the conservative Foundation for Government Accountability.

In the past, waivers have been granted to test new ways of delivering care and expanding Medicaid coverage. The only real requirements are that the waivers be budget neutral and promote the objectives of the Medicaid program.

Health and Human Services Secretary Tom Price, a former Republican congressman from Georgia and a vocal ObamaCare critic, has enormous flexibility in deciding what that means.

In March, Price and Seema Verma, who helms the Centers for Medicare and Medicaid Services, sent a letter to governors saying the administration would allow work requirements, larger premiums and other waiver provisions.

It was a dramatic departure from the Obama administration and “an open invitation” for states, said Robin Rudowitz, associate director for the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.

“By and large, Obama let states use waivers to expand the number of people in the Medicaid program,” Archambault said.

The Trump administration seems poised to do the opposite.

Critics say the proposed requirements go beyond the authority of the executive branch, but Archambault said the statute on what’s allowed is extremely broad, meaning the administration has the authority to approve most, if not all of the proposals.

Republicans in Congress have been deeply divided over Medicaid, with conservatives seeking to cut spending on the program but centrists from states where it was expanded under ObamaCare pushing back.

The House and Senate’s ObamaCare repeal bills sought to drastically cut back Medicaid spending by capping federal financing and ending ObamaCare’s enhanced federal funding for coverage expansion. The bills also would have given states the option of imposing work requirements.

Medicaid waivers can’t change the program’s financing the way a federal law could, but several state waivers filed months ago include a work requirement as a way to trim spending.

Work requirements “will have the result of cutting state Medicaid costs because fewer people will be on Medicaid,” said Deborah Bachrach, a partner at Manatt Health and former Medicaid director of New York.

To date, no state has received an approval for a waiver requiring people to work to be eligible for Medicaid. If the Trump administration approves of one, most experts think other states will get similar requirements approved quickly.

“If and when Kentucky and Arizona get approval ... you’ll see a bunch of other Republican states copycat,” Archambault said.

Other changes, if approved, include lowering the eligibility levels for coverage and a time limit for being on Medicaid.

Arkansas recently filed a waiver request to lower the Medicaid eligibility level while still receiving extra federal money as a Medicaid expansion state. It’s the first state to make such a request of the Trump administration; some states tried similar requests during the Obama administration and were denied.

Wisconsin would like to screen all and test some applicants for drugs. Those who test positive for drugs would be required to receive treatment; those who refuse to be screened or take a test would be ineligible for Medicaid benefits.

The state also wants to impose a 48-month limit on Medicaid eligibility, unless the person is working.

“My biggest concern is that the state is going to create a lot of new red tape and expense that is going to suppress Medicaid participation and increase total healthcare costs by putting greater reliance on hospital and emergency departments,” Jon Peacock, research director for Wisconsin-based Kids Forward, said.

Experts warn certain controversial provisions, if implemented, could be targets for lawsuits.

“Some of these waivers are pushing the boundaries of what has been approved before, and that could lead to potential litigation,” Rudowitz said. your social media marketing partner


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-3 # Old School Conservative 2017-08-03 15:13
I like the Wisconsin plan. If you are on drugs, you can enter treatment. If you are able bodied and don't work, you can enroll in job training. If you refuse to get treatment or enroll in job training, you get cut off.
+6 # desertprogressive 2017-08-04 00:13
Typical "Conservative" assumes that everyone on Medicaid is lazy, doesn't work, and/or is on drugs. Very self-righteous and judgmental.
+5 # warrior woman 2017-08-04 05:27
And if you're disabled? Can't work as a result?
+3 # librarian1984 2017-08-04 07:54
An article by Ralph Nader about single payer -- the system favored by Warren Buffett:

Nader hopes Buffett will supply $1 billion to fund a group of activists, 3 or 4 devoted to each of our 535 members of Congress, pushing them to move toward universal healthcare. This is an idea Nader has been talking about in recent years, that even a few dedicated citizen watchdogs could move Congressional mountains.

Buffet adheres to the idea, surprisingly uncommon among conservatives, that universal healthcare appeals because it reduces costs, primarily by cutting (insurance company) bureaucracy and administrative costs, which sometimes account for as much as 30% of total costs.

I'm not sure why conservatives hyperventilate about government 'death panels' but think it's perfectly okay from private, for-profit entities.

I guess when principles conflict with (insurance company) money, money wins.


OSC, my reply to you still hasn't appeared, though I don't believe it was offensive. I made two points: first, that job training is relatively meaningless when there are no jobs to train for (and millions more are expected to be lost to automation in the coming decades), and secondly, that drug testing, if implemented, should also apply to CEOs and boards of directors for any company that accepts federal subsidies.

That seems fair.
+1 # lfeuille 2017-08-04 19:54
Conservatives don't want to set of precedent of supporting government run programs even when they make sense for the corporate bottom line. They are afraid it will lead to a desire for more programs.
+1 # lfeuille 2017-08-04 19:58
This is the reason that the idea currently in vogue of basing a single-payer plan on Medicaid instead of Medicare won't fly. Medicaid is being gutted in red states. The program has to be national with not state money and no state rules or it won't be universal. "Everybody In, Nobody Out" won't fly in red states.
0 # ChrisCurrie 2017-08-07 08:32
They are not just "screw your neighbor Republicans", they are "kill your neighbor Republicans!"

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