Project 2025 Mandate for Leadership: The Conservative Promise, April 2024, The Heritage Foundation & partner organizations, Chapter 14: Department of Health and Human Services
Medicaid Reform Proposals (pp. 466-472)
[HJM bolding of narrative]
Reform Financing: Allow states to have a more flexible, accountable, predictable, transparent, and efficient financing mechanism to deliver medical services. This system should include a more balanced or blended match rate, block grants, aggregate caps, or per capita caps. Any financial system should be designed to encourage and incentivize innovation and the efficient delivery of health care services. Federal and state financial participation in the Medicaid program should be rational, predictable, and reasonable.
Direct Dollars to Beneficiaries More Effectively and Responsibly: End state financing loopholes. Reform payments to hospitals for uncompensated care. Replace the enhanced match rate with a fairer and more rational match rate. Restructure basic financing and put the program on a more fiscally predictable budget.
Strengthen Program Integrity: Incentivize states to decrease waste, fraud, and abuse. Improve Medicaid eligibility standards to protect those in need. Conduct oversight and reform of managed care.
Incentivize Personal Responsibility: Ensure that Medicaid recipients have a stake in their personal health care and a say in decisions related to the Medicaid program. Implement work requirements and match Medicaid benefits to beneficiary needs.
Allow Private Health Insurance: Enable states to contribute to a private insurance benefit for all family members in a flexible account that rewards healthy behaviors.
Increase Flexible Benefit Redesign Without Waivers: Eliminate obsolete mandatory and optional benefit requirements for able-bodied recipients. Redesign eligibility, financing, and service delivery of long-term care.
Eliminate Current Waiver and State Plan Processes: Allow providers to make payment reforms without cumbersome waivers or state plan amendment processes. Shift the balance of responsibility for Medicaid program management to states.
Prohibit Planned Parenthood from Receiving Medicaid Funds: End taxpayer funding of Planned Parenthood and all other abortion providers. Redirect funding to health centers that provide comprehensive health care for women.
Withdraw Medicaid funds for states that require abortion insurance: Cut 10 percent of Medicaid funds
Comment:
By Jim Kahn, M.D., M.P.H.
In my previous post, IÂ introduced Project 2025Â and the threats that it presents overall. Today is the first focused post â detailing the attack on Medicaid, our primary health insurance for the poor.*
As for understanding Project 2025âs Medicaid policy agenda, let me cut to the chase. The proposed changes, despite being couched in bureaucratic buzzwords, have a straightforward and nefarious intent: Reduce health insurance coverage for the poor, by restricting both eligibility and benefits. And, equally worrisome, use Medicaid to suppress access to abortion.
Hereâs the translation of Project 2025 policy jargon:
A âbalanced or blended match rateâ means less federal money (currently the majority of Medicaid funding), imposing a larger financial toll on states and thus lowering overall funding. âBlock grantsâ and âcapsâ means fixed funding, regardless of the size of eligible populations and their medical needs, and slow or no growth over time. âEnd state financing loopholesâ, âreform paymentsâ, and (again) âreplace enhanced match rateâ all mean: lower federal contributions. All this compromises providing care, see analyses here, here, and here.
âImprove Medicaid eligibility standards to protect those in needâ means: cover only the very poorest and sickest, leaving out many who currently qualify and who, in todayâs fragile health insurance environment, desperately need Medicaid.
âIncentivize personal responsibilityâ means â impose often onerous preconditions on getting Medicaid benefits. The example, âimplement work requirementsâ â which donât work.
âAllow private insuranceâ means abandoning the Medicaid public structure in favor of private insurance, which results in widespread under-insurance â especially dangerous for the poor.
âEliminate ⊠benefit requirementsâ means, well, removing requirements for specific medical services, thereby increasing risk. âRedesign ⊠long-term careâ means â undercut the mainstay of long-term care funding for the poor and middle class.
Layered onto this broad reduction in medical benefits is a full-bore attack on abortion services. I donât think I need to translate the language excerpted above, which is atypically clear and direct. More on this topic in an upcoming post.
Whatâs amazing about Project 2025 is the ability to rhetorically cast dangerous policies as being about efficiency, generosity to the sickest, and personal virtue. In contrast, we know that true efficiency and generosity are available in true universal health insurance â single payer. The security of excellent health care access will go a long way toward increasing societal virtue.
* As Iâve written previously, I very much look forward to the day when the phrase âhealth insurance for the poorâ no longer has meaning. Meantime ⊠we must maintain the program that provides for the medical needs of the economically vulnerable.
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