Plan to ‘Build Back Better’ Would Make Medicaid Bigger with Less Flexibility and Accountability


AMuch of the transformational health care policy is embedded in Democrats’ $ 3.5 trillion social spending bill, including the continuation of the Biden administration’s campaign to remove flexibility from the State and consolidate greater federal control over Medicaid.

Medicaid, the joint federal-state program to provide health care services to some low-income Americans, has seen an explosion in enrollments and spending.

The Centers for Medicare and Medicaid Services announced over the summer that a record 80 million Americans are enrolled in Medicaid, and federal spending on Medicaid has increased by approximately 19%.

At the same time, the Biden administration took unprecedented steps limit the ability of states to manage and stabilize Medicaid.

The “Build Back Better” plan, passing through Congress as part of a “budget reconciliation” process that will allow Democrats to pass it without any Republican votes, would accelerate these troubling trends and further expand the welfare state.

Most notable in the $ 3.5 trillion spending bill is the creation of a Medicaid-type program. Under the proposal, the federal government would establish and manage a new program to provide medical services to individuals in states that have chosen not to expand their own Medicaid programs.

This proposal would not only increase the number of Americans receiving government-run health care, but would also expand the role of the federal government in providing that care. Moreover, while the program appears narrowly focused, it is certainly reasonable to assume that it could be scaled up and pave the way for a full-fledged government takeover.

Rather than expanding the broken welfare state, President Joe Biden and Congress should focus on the root causes of the country’s health problems, such as costly regulations that increase health care premiums and reduce affordable coverage options.

The Build Back Better plan would also expand Medicaid’s role in providing long-term care services. If passed, the bill would create a grant program that would allow states to expand access to home and community services through Medicaid. This would increase the federal share of the costs for those states adopting this expansion, and the federal government would also bear a greater share of the associated administrative costs.

COVID-19 relief bills passed by Congress have already provided significant federal resources to the states, including an increase in Medicaid assistance during the duration of the public health emergency as well as for home and community services.

The spending bill would mean a significant and permanent increase in taxpayer spending on the Medicaid program and would exacerbate a growing shift towards the federal government assuming a larger share of the cost of Medicaid.

The use of Medicaid to solve long-term care problems is short-sighted and poorly targeted. Expanding the role of government in providing long-term care services eliminates private options and expands an already overburdened safety net for the poor.

Rather than expanding Medicaid’s role in long-term care, Congress should promote private alternatives, preserve the safety net for those already dependent on it, and reduce long-term dependence on Medicaid.

The Build Back Better plan would also undermine state flexibility by imposing new federal requirements on states.

Under Medicaid, the federal government sets ground rules, and states have significant power to design their own programs within those parameters. The expenditure bill would change the status of certain populations and services from optional to compulsory. Rather than giving states the flexibility to tailor programs to meet their unique demands and needs, this proposal would reduce states’ flexibility in favor of federal eligibility and benefit mandates.

Finally, the Democrats’ bill would also make policy changes that would weaken oversight and accountability for these programs. Specifically, the bill would require some registrants to stay on Medicaid for an entire year, regardless of changes to their eligibility status.

The bill would also facilitate the Medicaid registration process by making “express” eligibility determinations. And the bill would permanently expand the children’s health insurance program and its funding, removing the need for regular review of the program by Congress and essentially putting it on autopilot.

These actions would deprive states of flexibility, remove responsibility for these programs, and expand government control over Medicaid and health care in general. Rather than expanding the role of government in health care and imposing more federal mandates and requirements on states, Congress should give states greater flexibility manage the needs of their citizens without increasing costs.

This fight for health care is about control over money and decisions. It’s a choice between a one-size-fits-all federal solution that prioritizes Washington or a flexible solution that prioritizes Americans in need and their loved ones.

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Original author: Nina Owcharenko Schaefer

Original location: Plan to ‘Build Back Better’ Would Make Medicaid Bigger with Less Flexibility and Accountability


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