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 ProposalsĀ (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 beĀ rational, predictable, and reasonable.
Direct Dollars to Beneficiaries More Effectively and Responsibly: End state financing loopholes.Ā Reform payments to hospitalsĀ for uncompensated care.Ā Replace the enhanced match rate with a fairer and more rational match rate. Restructure basic financing and put the program on a moreĀ fiscally predictable budget.
Strengthen Program Integrity: Incentivize states to decrease waste, fraud, and abuse.Ā Improve Medicaid eligibility standardsĀ to protect those in need. Conduct oversight and reform of managed care.
Incentivize Personal Responsibility: Ensure that MedicaidĀ recipients have a stake in their personal health careĀ and a say in decisions related to the Medicaid program.Ā Implement work requirementsĀ andĀ match Medicaid benefits to beneficiary needs.
Allow Private Health Insurance: Enable states to contribute to aĀ private insurance benefitĀ for all family members in a flexible account that rewards healthy behaviors.
Increase Flexible Benefit Redesign Without Waivers: Eliminate obsolete mandatory and optional benefit requirementsĀ for able-bodied recipients.Ā Redesign eligibility, financing, and service delivery of long-term care.
Eliminate Current Waiver and State Plan Processes: Allow providers to makeĀ 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.Ā 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, IĀ introduced Project 2025Ā and the threats that it presents overall. Today is the first focused post ā detailing the attack on Medicaid, our primary health insurance for the poor.*
As for understanding Project 2025ās 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.
Hereās the translation of Project 2025 policy jargon:
A ābalanced or blended match rateā means less federal money (currently the majority of Medicaid funding), imposing a larger financial toll on states and thus lowering overall funding. āBlock grantsā and ācapsā means fixed funding, regardless of the size of eligible populations and their medical needs, and slow or no growth over time. āEnd state financing loopholesā, āreform paymentsā, and (again) āreplace enhanced match rateā all mean: lower federal contributions. All this compromises providing care, see analysesĀ here,Ā here, andĀ here.
āImprove Medicaid eligibility standards to protect those in needā means: cover only the very poorest and sickest, leaving out many who currently qualify and who, in todayās fragile health insurance environment, desperately need Medicaid.
āIncentivize personal responsibilityā means ā impose often onerous preconditions on getting Medicaid benefits. The example, āimplement work requirementsā ā whichĀ donāt work.
āAllow private insuranceā means abandoning the Medicaid public structure in favor of private insurance, which results in widespread under-insurance ā especially dangerous for the poor.
āEliminate ā¦ benefit requirementsā means, well, removing requirements for specific medical services, thereby increasing risk. āRedesign ā¦ long-term careā means ā 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 donāt think I need to translate the language excerpted above, which is atypically clear and direct. More on this topic in an upcoming post.
Whatās 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 ā single payer. The security of excellent health care access will go a long way toward increasing societal virtue.
* As Iāve written previously, I very much look forward to the day when the phrase āhealth insurance for the poorā no longer has meaning. Meantime ā¦ we must maintain the program that provides for the medical needs of the economically vulnerable.
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