While President Donald Trump’s efforts to repeal and replace Obamacare have dominated the news, he also plans to reform a larger and arguably more broken program: Medicaid. In an interview with NBC’s “Today” show, Trump advisor Kellyanne Conway said Trump wants to “block-grant Medicaid to the states” to ensure “those who are closest to the people in need will be administering.”
Conway’s comments echo Trump’s campaign promise to “maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their low-income citizens.” Block grants would cap federal Medicaid funding and let states decide how to use those dollars. It would introduce flexibility and budget discipline to a program that sorely needs both.
Medicaid Soaks Money Away From Other Priorities
Since its inception in 1965, Medicaid has operated as an open-ended entitlement. The more state Medicaid programs spend on health-care programs for designated recipients, the more the federal government reimburses them. On average, states receive $1.33 for every $1 they spend on Medicaid.
While Medicaid’s current framework sounds like a generous deal for states, Medicaid’s funding formula incentivizes policymakers to expand the program at the expense of core state government functions. A report by the Mercatus Center shows that as Medicaid’s share of state budgets grow, state spending on roads, schools, and public colleges shrink.
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