We are in a series looking at the recently published Republican plan for the ‘repeal and replace’ of the Affordable Care Act. Click here to find other posts in the series.
Now we get to the hard part…Medicaid.
Here’s what any ‘replace and replace’ plan gets to balance:
On one hand, 72 million people (more than one in five people) are covered by Medicaid. Because participation in this program is transitory, almost one in three people are covered by this program during any given year. That is up 15.7 million since 2013, when Medicaid expansion kicked in under the ACA, and 85% of that increase came from the states that expanded Medicaid.
On the other hand, the cost of this expansion is simply unsustainable. Already, Medicaid consumes a quarter of the average state budget and combined federal and state spending on Medicaid is on track to reach $1 trillion by 2025.
So you wonder about the angry town hall meetings? A lot of folks that just got a new entitlement and now they aren’t too thrilled at the prospect of losing it, no matter what the spreadsheet says.
Add to that the politics of it all and you see this one is perilous.
So the Republican plan is to:
Medicaid reform, in short, can be summarized as, ‘Here’s your allowance…go get ‘em Tiger.’
Simple math says something’s gotta give. This plan, with its ’50 state laboratories of innovation’ banner, pushes the decisions, and likely the backlash, down to the governors.
One more reason this is complicated. Who knew?BACK TO LIST
Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.