The “repeal and replace” bills debated in both the House and Senate would go beyond repealing Obamacare, by converting Medicaid from an entitlement program to block grants. Currently, Medicaid spending is driven by enrollment growth and utilization. If more people qualify and use more services, then spending goes up. Under a block grant, spending is capped, either on an overall basis or per enrollee.
On a certain level, the block grant concept is appealing. States will have a fixed pool of funds to work with and the flexibility to decide who is covered and for what. Each state can make its own decisions, based on local priorities, rather than have the federal government dictate the rules. Medicaid spending has been growing rapidly, proponents of block grants believe they are a logical way to bring Medicaid spending under control.
Opponents of the block grant approach point out that Medicaid is the primary funder of healthcare for vulnerable populations, including children. Under the current system, access to certain services and benefits is guaranteed. That would change if the House or Senate bill –and block grants– became law.
For example, the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit is currently mandated, but under a block grant program states would no longer be required to offer it. EPSDT was enacted in response to a military threat. In 1967, at the height of the Vietnam war, the military complained that it was having to reject too many draftees due to medical issues that were untreated in childhood. EPSDT was designed to improve the health of children and bolster long-term military readiness.
EPSDT promotes identification of medical issues at an Early age, Periodic medical visits, Screenings for developmental and mental health issues, Diagnostic follow-up if needed, and Treatment for health risks. ESPDT helps prevent early issues from developing into full-blown problems by paying for care early on and by covering needed services even if they aren’t otherwise offered by a state’s Medicaid program. ESPDT enables children from lower income families to obtain coverage comparable to what privately insured children receive.
Medicaid and the related CHIP program cover more than two million children with special healthcare needs, according to the Kaiser Family Foundation. ESPDT and other targeted benefits are designed to ensure that this vulnerable population is protected and nurtured.
Much of the debate about the Affordable Care Act (aka Obamacare) is rooted in partisan politics and abstract principles, but the discussion quickly gets messy once the impact on vulnerable populations is considered. If we want our society to be judged by how we treat its least powerful members –or even if we just want to ensure a healthy workforce and hearty pool of military recruits—the implications of healthcare reform on vulnerable populations cannot be glossed over.