Editors at National Review Online analyze congressional Republicans’ proposed Medicaid reforms.
Democrats say that Republicans are proposing steep cuts and fundamental changes to Medicaid. We wish. The reality is that the House Republicans passed a modest series of tweaks to the program that won’t do much to alter its spending trajectory.
Washington is currently engaged in a semantic debate over whether those tweaks amount to a Medicaid “cut,” which President Trump has said he opposes. More important is what the legislation would actually do.
Its main thrust on Medicaid is to adopt good-government measures that save money, rather than try again to repeal the Obamacare Medicaid expansion.
For instance, federal dollars are not supposed to finance Medicaid benefits to illegal immigrants, yet 14 states and the District of Columbia cover them anyway. The bill would have the federal government send less Medicaid money to those states in order to discourage the practice, or at least ensure that taxpayers in the other 36 states do not foot the bill. Republicans would also impose a new requirement that states obtain addresses from Medicaid enrollees, a bare minimum for stopping fraud. In 2012, the Supreme Court ruled that states were free to decide whether to take part in Obamacare’s expansion of Medicaid. The 2021 Biden stimulus bill provided additional financial incentives to the holdout states. Republicans would eliminate those. They would also make able-bodied adults work for at least 20 hours a week to receive benefits.
An additional measure would affect the ability of states to tax providers (such as hospitals and nursing homes). This is a scam by the states: They “tax” the providers, raise their health spending (which largely goes to the providers), and draw additional federal dollars for making this on-paper contribution to health care. The Republican bill wouldn’t eliminate the taxes, but would limit their abuse.
