Although the AHCA died in its current form, that doesn’t mean Medicaid is safe at the State level, even in states that participate in Medicaid Expansion.
These initiatives are independent of efforts to find a Republican consensus on Repeal, Replace, and Repair in the House of Representatives.
The initiatives are focusing on using the flexibility of the ACA waiver provisions to advance conservative policy outcomes. The idea is that the states will ask CMS to approve changes in their waivers that will produce policy that the Obama administration routinely denied.
Some of the proposals include:
- Work requirements
- Lifetime limits on benefits eligibility
- Premium contributions
- Enrollment waiting periods
- Lockouts of eligibility if premiums aren’t paid on time
- Lockouts for failure to recertify eligibility in a timely way
The obvious overall effect of these is to reduce Medicaid enrollment. Since not being on Medicaid is not a cure for any health care issue, the burden of care will fall, as it did before the ACA on hospital emergency rooms and other treatment systems that are already overburdened and short on resources.
These choices will have an impact on hospital systems as it has in the past but without the supplemental funding for uncompensated care that was part of Medicaid before the ACA.
These policy proposals will nickel-and-dime the Medicaid system into chronic low-grade failure over time.
Some states have already submitted waiver requests (AZ, IN, KY, & PA).
More on this issue as it becomes available.