Medicaid came up during the Senate Finance Committee hearing for the appointment of Congressman Tom Price (R-GA) to be the next Secretary of Health and Human Services. In the questioning, he defended the proposals that have been offered to convert Medicaid into a block grant but he never committed to supporting one.  When pressed by senators about past budgets he has voted for and helped write that included Medicaid block grants he deferred on taking a formal position. There was also discussion in the Budget Committee hearings when Congressman Mick Mulvaney (R-SC) was asked about his past positions on entitlements and block grants.  He indicated he would still advocate for significant changes to entitlements regardless of President Trump’s past campaign statements about protecting some of these programs.

Last week also brought together an advisory group that specializes in Medicaid and CHIP (Children’s Health Insurance Program), MACPAC. MACPAC stands for the Medicaid and CHIP Payment and Access Commission. It is a non-partisan legislative branch agency that has as its mission to provide policy and data analysis.  The Commission makes recommendations to Congress and HHS.  Last week at one of their regular meetings Commission Chairperson Sara Rosenbaum was quoted as saying that what Congress is considering could represent, a “major shift in federal policy” when it comes to “vulnerable populations.”  The Commission meeting on this past Thursday is described as a first step in some very deep analysis.  She described any of their work as “a lengthy exploration” and “extraordinarily complicated” MACAPAC collects Medicaid data and information and that information indicates that Medicaid currently takes up about 15 percent of state budgets (and 9.5 percent of the federal budget).  In 1988 Medicaid represented 6 percent of state budgets. According to their analysis,

“Medicaid accounts for a large share of state budgets, about 40 percent of state and local government spending on health care, and nearly half of state spending from federal funds.”

Proposals to block grant Medicaid would essentially put a cap on federal spending, and depending how that block grant is designed, would leave states to absorb future health care increases that exceed a federal block grant or capitated payment limitation.  This becomes especially significant as an aging baby boom population places pressure on needed long term health care costs.  Medicaid provides 32 percent of nursing home costs nationally.

Congressman Price has been challenged on his past stock investments that were impacted by legislation he was involved with and Congressman Mulvaney has been challenged on his past failure to pay Social Security taxes on domestic help but both controversies have failed to get public or Senate Republican reaction likely meaning their nominations should move forward.