To Cut or to Reform Medicaid?
The GOP’s attempt to repeal and replace the Affordable Care Act has generated intense opposition and run into repeated roadblocks on Capitol Hill, despite advancing many worthy reforms. The proposals are right to allow individuals without pre-existing conditions to obtain insurance from a freely-competitive market, right to shift able-bodied individuals from Medicaid to the exchanges, and right to restructure Medicaid so that the largest share of its funds is not captured by the wealthiest states that need it least.
Yet, the $904 billion in aggregate spending cuts incorporated in the most recent bill have fueled bitter opposition to the proposed reforms. The GOP has long struggled to balance its objectives of enhancing competition and personal responsibility with a desire to immediately save money. Well-designed institutions save money over the long-term, but a haste for savings has ensured that the main thing many states, providers, and individuals see in the GOP’s reform proposals is the prospect of having to make do with less.
The blueprint for the GOP’s 2017 attempt to repeal and replace the Affordable Care Act was laid out by Speaker Paul Ryan in his June 2016 proposal, “A Better Way.” That white paper proposed “more choices, lower costs, greater flexibility” in health insurance, set out the case for reforming Medicaid into a per capita allotments for states, and argued for transforming Medicare into a “fully-competitive market-based model”.
This piece originally appeared in The Morning Consult