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Republicans float dueling Medicaid reform bills
House Republicans are floating dueling Medicaid reform bills as Budget Committee Chairman Paul Ryan (R-Wis.) prepares to unveil his own proposal in the coming weeks.
Leaders of the conservative Republican Study Committee will introduce legislation on Wednesday that gives states maximum flexibility to run the program as they see fit. The "State Health Flexibility Act" would combine Medicaid and the Children's Health Insurance Program (CHIP) into a single block grant, while reducing federal spending on the two programs by $1.8 trillion over 10 years by freezing spending at current levels.
The bill would allow states to determine eligibility, benefits, provider reimbursement rates and many other aspects of the program. That makes it incompatible with the healthcare reform law, which calls on the Medicaid programs of all 50 states to cover everyone up to 133 percent of the federal poverty level.
"It's not compatible with the [healthcare reform law]," Rep. Paul Broun (R-Ga.) told The Hill. "There's no question."
The bill will be introduced by freshman Rep. Todd Rokita (R-Ind.). Broun is a lead co-sponsor, along with Rep. Tim Huelskamp (R-Kan.) and RSC Chairman Jim Jordan (R-Ohio).
Separately, Energy and Commerce member Bill Cassidy (R-La.) has been touting his own Medicaid reform proposal, which would replace the current open-ended federal matching rate system for states with a per patient, per month budget depending on the characteristics of each state's patient population.
Unlike the RSC bill, Cassidy's proposal, which is still being developed, could work regardless of what happens to the healthcare reform law. He said that unlike a block grant, his proposal would have federal Medicaid money follow patients so that states would not be penalized if their populations change, such as after Hurricane Katrina when many Louisiana Medicaid patients sought refuge in Texas and other states.
However, many Republican governors have been clamoring for block grants so they can take over their Medicaid programs. Ryan's budget last year called for turning Medicaid into a block grant while cutting federal spending on the program by about $750 billion over 10 years; the budget proposal however only changed the financing mechanism for Medicaid, leaving the details of how much flexibility to give to states to authorizing committees.
Last year, leaders of the Republican Governors Association — Chairman Rick Perry of Texas, Vice Chairman Bob McDonnell of Virginia, Policy Chairman Haley Barbour of Mississippi and Policy Vice Chairman Chris Christie of New Jersey — wrote to Ryan to endorse his call for block granting Medicaid. And Broun said his state's governor, Republican Nathan Deal, fully supports the RSC bill.
Critics say block grants would harm Medicaid patients by cutting funding and allowing states to drop people off the rolls and slash benefits, especially during economic downturns when more people automatically become eligible for the program.
