Dylan Matthews · Monday, March 20, 2017, 8:23 pm
The American Health Care Act — House Speaker Paul Ryan's and President Trump's proposal to replace Obamacare — was in its original form a truly massive cut to Medicaid. It slashed the program by $880 billion over ten years, according to the Congressional Budget Office. It would eventually unwind the Medicaid expansion included in the Affordable Care Act and slash the yearly growth rate for Medicaid spending, forcing states to provide worse coverage or to kick people off the rolls.
Now it’s about to get harsher.
The “managers’ amendment” changing the legislation, which is set to be released Monday night by House leaders and expected to be adopted through a House Rules Committee vote before the full House votes on Thursday, includes new provisions cracking down on Medicaid beneficiaries. The changes would allow states to impose work requirements on able-bodied childless adults getting Medicaid, and to receive funding in a "block grant" that doesn't rise at all with enrollment, which would likely amount to a still-larger cut.
The measures were reportedly adopted to win over House conservatives, like Republican Study Committee’s leader Rep. Mark Walker (R-NC), who vocally opposed the bill at first. Walker is now on board with the plan after securing the Medicaid changes. “The president asked us specifically: Would we support him on this American Health Care Act [with the increased Medicaid restrictions]," Walker told the Washington Post's Mike DeBonis. "We all agreed, to a man.”
The original legislation was already a historic cut to aid for the poor. “No legislation enacted in recent decades cut low-income programs this much — or even comes close,” the Center on Budget and Policy Priorites’ Robert Greenstein told me when the CBO’s score was released. But the two new provisions — allowing work requirements and enabling states to take a block grant — are both major changes that will diminish access to Medicaid even further. They make a bill that already represented a historic cut to the health care safety net for poor Americans even more harmful.