Th Hill - Medicaid block grants give states more freedom

Op-Ed

By Bruce Westerman

When I ran for Congress in 2014, I ran on a simple platform of less hassle, more freedom. In the two years I have served as the representative from the Fourth District of Arkansas, I have fought to make that platform a way of life back home and across the country.

When leaders in the Republican Party introduced the American Health Care Act (AHCA), I was not sold on the legislation. While it took important steps to repeal and replace ObamaCare, it did not do enough to give individuals and the states in which they live the freedom to do healthcare in a way that works locally instead of depending on mandates from Washington, D.C.

As the legislation worked its way through Congress, I have been working behind the scenes to ensure conservative policies and principles were included in the AHCA.

When the bill came before the House Budget Committee, I was able to work with others to secure agreements from leadership and President Donald Trump that Medicaid block grants would be included in the final version of the bill scheduled for a vote this week.

The Medicaid program was originally created to assist the disabled and elderly but has grown to cover impoverished children and able-bodied adults. It is very inflexible and heavily mandated from Washington. Flexibility to change or update the program for the needs of individual states must go through the secretary of Health and Human Services and ultimately the president. The federal government has not been inclined to give states much flexibility to spend Medicaid dollars in innovative ways that meet the particular individual needs of the state's Medicaid population.

With Medicaid block grants, it is the exact opposite. States are provided the dollars needed to build a Medicaid program without having to seek approval from the feds. Medicaid funding amounts are centered on a base year's aggregated Medicaid-spending and any increase in Medicaid funding is tied to an inflation factor such as the Consumer Price Index (CPI).

A large component of ObamaCare has been the introduction of Medicaid expansion, a program that provides health insurance coverage not to the elderly or disabled, but instead gives it away to able-bodied, working age adults with no work requirements attached. Under current laws, states like Arkansas, which have taken the expansion, have to go through the process of seeking HHS approval to implement something as simple as work requirements for the working-age adults who take the free insurance and are capable of work but don't always choose to.

The result of Medicaid expansion has been nearly 368,000 able-bodied, working age Arkansans collecting free insurance while a waiting list for the truly disabled in need of traditional Medicaid has grown. That is why I fought for the introduction of Medicaid block grants in the AHCA. States that accept the block grants would be able to build integrity into their Medicaid programs and would have the regulatory flexibility to design innovative plans that work best for their citizens instead of a one-size-fits-all plan from D.C. Nonsense features like state provider fees designed to simply milk more federal money by charging a state tax on Medicaid services in order to get the federal match dollars should go away under true block granting. By prioritizing state spending, individuals who are in true need would finally be able to get off the waiting list and receive necessary, life-saving care.

Many states could benefit from the block grants included in this legislation, including Arkansas. Gov. Asa Hutchinson expressed his support for Medicaid block grants in a letter to Budget Committee Chair Diane Black (R-Tenn.), stating that Arkansas supports the inclusion of block grants and could accept the grants once available. Gov. Paul LePage of Maine comes from a state that did not accept Medicaid expansion yet he also sees the benefits of Medicaid block grants in providing improved, more efficient care for the citizens of Maine. He, like Hutchinson, wrote House leadership in support of block grants.

Repeal and replace through reconciliation is just the first step in a full repeal of ObamaCare. I have worked with my colleagues in the House and the Republican Study Committee to make this legislation more conservative through block grants and other improvements such as work requirements for able-bodied, working age adults.

I fully anticipate the Senate to provide conditional enhancements to the bill to make it even stronger as they offer amendments that can pass the muster of budget reconciliation rules. But as Speaker of the House Paul Ryan (R-Wis.) and Health and Human Services Secretary Tom Price have said, the fight to repair the damage created by ObamaCare is not over. This week's vote will be followed by administrative reforms at HHS and additional legislative actions in the House and Senate. In the end, Americans will have less hassle and more freedom in healthcare based on free market policies that will lower cost while improving coverage and care

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