The revised Cassidy-Graham bill to repeal and replace the Affordable Care Act, or ACA, proposes converting Medicaid into a per capita cap and replacing Medicaid expansion funding and marketplace subsidies with a much smaller block grant.
Capping Medicaid would not be responsive to actual health care needs, effectively disconnecting low-income Floridians from access to affordable and quality health care. This would particularly hurt children, seniors and people with disabilities. It would expose them to exorbitant out-of-pocket costs, limited access to medical care, worse health outcomes and increased risk of premature death.
It’s important to provide some historical context on the block grant model and how it’s been applied to anti-poverty programs.
Federal block grants have been touted as a way to provide local control and give states flexibility in how they spend federal dollars. The Florida Policy Institute recently published a case study of the Temporary Assistance for Needy Families program, or TANF, examining how federal dollars were allocated following the 1996 welfare reform, the basis of which was block granting. We found that, between 2008 and 2016, increasingly fewer TANF dollars were allocated for the core purpose of the program, to help people in poverty and deep poverty transition from government assistance to employment and self-sufficiency. In 1996 the program reached 55 out of every 100 eligible families; in 2015, it reached only 11 out of 100. Further, we found that as of 2015, only 12.3 percent of TANF cases were closed because the recipient found employment.
Block granting ultimately results in fewer or reduced-quality services, or both. It negates the ability of federal funding to address demonstrated funding needs, especially in states with high population growth. Block granting would make it much harder for states to respond to increased health care needs in the face of hurricanes, economic recessions or public health crises like Zika. When applied to health care, this model could endanger the lives and livelihoods of Floridians when they need access to vital health care services the most.
Preserving the financial structure of the Medicaid program and shoring up the health insurance marketplace under the ACA helps make health care more accessible and affordable for all Floridians. The Cassidy-Graham bill does neither.