Earlier this year, just before the coronavirus pandemic, the Trump administration launched a program allowing states opt out of traditional Medicaid, the state-federal health insurance program for low-income people, and instead receive a block grant from the federal government.
Trump’s block grant program, widely seen as a back-door way of killing Obamacare, is billed as giving states more flexibility to address local needs because it allows them to spend the federal dollars with far fewer restrictions.
The pandemic has shown why the Medicaid block grant idea, which has been backed in the past by U.S. Sen. Cory Gardner and other Colorado Republicans, is a bad idea, say experts.
One of the great benefits of Medicaid, they say, is its ability to expand quickly to meet the demands of a health care crisis, like the coronavirus pandemic.
Ross Brooks, who directs Mountain Family Health Centers in Colorado’s central mountains, says block grants don’t end up giving states more flexibility, primarily because they create spending caps that can be devastating to local health care systems, especially in rural areas.
In a pandemic like this one, the spending caps could prevent budget-strapped states from adding citizens to their Medicaid rolls because states could easily burn through the grant money, said Brooks during a press conference organized Thursday by Protect Our Care, a progressive advocacy group.
As it stands now, an additional 200,000 to 300,000 Coloradans will likely be added to Colorado’s Medicaid rolls in the next six months, said Brooks, due to job and concurrent health insurance losses.
If Colorado had a block grant, “it would squash the ability of the state to respond to the coronavirus,” said Brooks, leaving Colorado likely unable to cover so many additional residents.
This would be particularly devastating to rural Colorado, where more residents (17%) are uninsured or face barriers to health care access than in non-rural areas, according to a just-released Protect Our Care report arguing that Medicaid has been an “essential tool” to help rural Colorado fight the coronavirus pandemic. In rural parts of Colorado, 26% of citizens get their health insurance through Medicaid, a figure that’s increased dramatically under Obamacare, which allowed an additional 450,000 Coloradans to get Medicaid insurance, according to the report.
Asked last month by the Colorado Times Recorder if the alleged flexibility of a Medicaid block grant might help Colorado during a pandemic, Adam Fox, Director of Strategic Outreach for the Colorado Consumer Health Initiative, said a loss of funding resulting from the block grant would damage Colorado’s health care system.
“This [block-grant] model would harm states in the current crisis,” said Fox. “By capping funding, block grants would make it harder for states to meet their needs within the Medicaid program as they fluctuate. It would hamstring the state’s ability to respond to changing needs and eventually would lead to Medicaid coverage being eroded as funding does not keep up with our evolving health care needs and landscape.”
Colorado Democrats in Congress spoke out against Trump’s Medicaid block-grant initiative, called Healthy Adult Opportunity after the president first offered states the chance in January to seek the waiver to get the federal block grant.
In February, Colorado’s House Democrats voted for a measure expressing disapproval of Trump’s block grant executive order, while Colorado’s House Republicans, Doug Lamborn, Scott Tipton, and Ken Buck voted against the House resolution condemning Trump’s Medicaid plan.
Boulder Democrat Joe Neguse said through a spokesperson in March that he “vehemently” opposed the block-grant idea, which he called a “direct assault on a critical lifeline that thousands of families across Colorado rely on.”
Aside from the House vote, Colorado Republicans were mostly mum on the Trump block grant proposal.
U.S. Senator Cory Gardner (R-CO) has signaled his support for Medicaid block grants, most recently in his votes to repeal Obamacare.
But his support for the policy goes back to his term in the U.S. House of Representatives, from 2010-2014, where he cast a series of votes, like this one, for the so-called Ryan budget, which would have, among other things, transformed Medicaid into a block grant program.
Gardner’s office didn’t return a call for comment.
“We need Congress and the administration to shore up Obamacare,” said Colorado state Rep. Dylan Roberts of Avon, who has backed proposals to build on the national health care law. “If a global pandemic doesn’t make that clear, I don’t know what does.”