American voters consistently name health care as one of the issues they care about most heading into the presidential election. That’s bad news for President Donald Trump, who gets bad marks on health issues after his party’s attempt to gut the Affordable Care Act failed and backfired. Instead of changing strategies, though, he is doubling down on unpopular policies.
On Thursday, officials announced that the administration will allow states to pursue what it dubs “Healthy Adult Opportunity” initiatives. The new name is just a dystopic rebranding of “block grants,” which itself is more palatable code for “cap Medicaid funding and strip health benefits from poor Americans.”
The plan is another in a series of efforts to weaken Medicaid, a popular insurance program for low-income and disabled Americans that was expanded by the ACA. The president is playing with political fire for a bad idea that may never see the light of day.
Medicaid funding is currently open-ended; the federal government provides matching funds for state spending, adjusted for per-capita income. That entitlement enables states to expand services and makes the program exceptionally resilient.
Block grants would replace that obligation with fixed payments. Proponents argue that this would boost flexibility, allowing states to manage the program and control costs better. Opponents point out that a fixed budget leaves states in a bind when the economy deteriorates, and more people need Medicaid. States also would run into issues during public health crises, and may be stymied as novel and expensive treatments hit the market. They would likely have to cut eligibility and services over time, and Trump’s proposal would give broad freedom and significant incentives to do so.