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The Trump administration will open yet another front today in its never-ending War on Every Last Thing Obama Ever Did Including Breathing, rolling out a proposal to allow states to request their Medicaid funding be allotted in annual block grants instead of the current system, where the states and federal government share funding for everyone who qualifies. It's the fulfillment of a long-term conservative wet dream to cap the amounts spent on medical assistance for low-income Americans, because Those People shouldn't get sick if they can't afford it.

The plan even has an appropriately Orwellian name: "Healthy Adult Opportunity." The block grants would apply only to Medicaid funding for adults who qualify for coverage under the Affordable Care Act's expansion of Medicaid. The new name for Medicaid cuts is a nod to a favorite rightwing myth, which claims Obamacare made Medicaid available to too many low-income adults in good health -- Ronald Reagan's "strapping young bucks," in case you needed the translation -- who don't "deserve" it.

So yay! Trump will create "opportunity" by taking poor people's medical care away, and then the lazy takers will finally realize they need to work. They'll surely rush out and get one of the jobs that are simply falling off the trees these days, especially in economically distressed areas where unemployment is as high as 24 percent. Clearly, that's only because people are lazy.

Also, let's remind y'all once more that most adults receiving Medicaid already work.


The block grant -- sorry, opportunity -- scheme would allow states to apply for a waiver from the current Medicaid expansion funding formula, in which the federal government covers nearly all of the costs of the expanded program. The block grants would instead cap the amount available each year for adults covered by expanded Medicaid, and would also allow the states to "limit health benefits and drugs available to some patients." Hey! That sounds like rationing! And since Medicaid restrictions will lead to people going without healthcare, we may as well say death panels.

Now, even though states are actually getting a great big healthcare subsidy by expanding Medicaid -- the state share of expansion coverage is about 5 percent or less -- Team Trump is nonetheless selling the block grants as a way for states to save money. This is because they are ghouls, every single one of them. Let's also not forget that back in the Before Times, Donald Trump "promised" not to cut Medicaid:

Haha, we are joking of course. Donald Trump never keeps promises, and besides, there's no evidence he ever learned the difference between Medicare and Medicaid, even if people told him. And remember, he's not cutting anything, he's creating opportunities!

Politico notes the block grant plan is the brainchild of Seema Verma, Trump's director of the Centers for Medicare and Medicaid Services (CMS). Verma, who considers the ACA a "disaster," spent a year designing the scheme, and has "framed the plan to colleagues as a signature initiative of her tenure," because a smoking crater in the ground is a hell of a thing to shoot for as a legacy. Politico also informs us that Verma and her boss, Health and Human Services Secretary Alex Azar, have been fighting to win Donald Trump's affections, like the cast of "The Jersey Shore" in a production of King Lear. But today at least, they'll appear together at the announcement, no doubt each with a dagger tucked somewhere handy.

Needless to say, Verma's already prepared to spin cutting healthcare to poor people as not hurting anyone at all, or at least only hurting the people who need it:

Aware of criticism that any cap on Medicaid funding would target vulnerable patients, Verma will stress during Thursday's announcement that her plan, by focusing just on the Obamacare expansion, will not affect the poorest or disabled patients. Verma has long argued Medicaid expansion is siphoning away resources from the most vulnerable patients covered by the program. CMS will frame the block grant as a way for states to reinvest any savings into care improvements for Medicaid beneficiaries.

See? The neediest people won't be hurt, so let's hurt the slightly less needy! And think of how the savings could help the "truly" needy! But from what we've seen, there doesn't appear to be any requirement the money go to healthcare. It might go to something the states find more important, like preserving Confederate statues.

The block grants will include at least a token mechanism aimed at measuring outcomes:

States will be required to report their performance in real time, such as whether Medicaid patients see declines in access to providers or health outcomes, which one official said would allow the administration to gauge whether the block grant was truly working to make adults healthier.

We do have some questions, though: is there anything aimed at preventing the administration from dishonestly spinning such stats, like claiming fewer visits to providers is a sign that people are getting healthier instead of being denied access when they need it? Republicans are awfully good at shit like insisting that people being thrown off food stamps proves they no longer need help.

Democrats and healthcare advocates are vowing to fight the new rules, noting that a similar scheme to gut Medicaid with block grants was killed off when Republicans tried to repeal Obamacare in 2017. But no bad GOP ever really stays dead.

t's also entirely possible the block grant program will be tied up in the courts for the rest of Trump's term, Politico notes, because critics of the change argue that annual caps on spending violate Congress's intent in writing the Medicaid law specifically so funding matches the medical needs of those who qualify, not an arbitrary limit. The "opportunity" grants could also run afoul of the same problem that has stymied Trump and Verma's effort to impose work requirements on Medicaid recipients: Judges keep finding the work rules, which cause tens of thousands of people to lose benefits, violate the "core objective" of Medicaid, which is to provide medical care to people in need.

Ah, but who's to say which people are really in need? It's always fun to insist that some poor people have to suffer so we can help other poor people. Making different groups of people with little political power fight each other for crumbs is a classic Republican strategy, not to mention a favorite genre for Fox News.

[Politico / Kaiser Family Foundation / Urban Institute]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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