GOP pushes to slash Medicaid

WASHINGTON -- Nearly half a century after President Lyndon B. Johnson signed Medicaid into law, conservative critics of the massive government health insurance program for the poor are readying a new push to dramatically scale it back if Republicans control the White House and Congress next year.

GOP governors, emboldened by the Supreme Court decision on President Barack Obama's health care law, are already balking at expanding Medicaid to meet the goals of the Affordable Care Act.

Some are rolling back coverage now, arguing that the program is ineffective and unaffordable.

At the same time, congressional Republicans, backed by influential conservative activists, are renewing calls to convert Medicaid into a series of smaller grants to states, reprising the successful GOP strategy that cut cash welfare programs in the mid-'90s.

Former Massachusetts Gov. Mitt Romney, the presumptive GOP presidential nominee, has thrown his support behind a block grant plan that would cap federal spending, effectively slashing Medicaid funding by more than $1.5 trillion over the next decade in what would be the most sweeping change in the program's history.

One of Romney's lead health care advisers, Dr. Scott Gottlieb, has claimed that Medicaid is "worse than no coverage at all."

Virginia Gov. Bob McDonnell, chairman of the Republican Governors Association, said states, which operate their own Medicaid programs, could handle cuts. "If the federal government would take off a lot of the micromanagement and the bureaucracy, we could probably get by with even less money," he said.

But the drive to cut federal aid is stoking rising concern among hospitals and other medical providers that Medicaid cutbacks would swell the numbers of the uninsured.

"We know that coverage saves lives," said Dr. Bruce Siegel, president of the National Association of Public Hospitals and Health Systems. "People who have coverage are healthier. They live longer. And they are more financially secure. That is all at risk for millions of our neighbors."

Siegel called the GOP campaign the most serious threat to Medicaid in decades.

The 2010 health care law is designed to make Medicaid the foundation for universal health coverage by guaranteeing insurance to all poor Americans for the first time.

Today, the program primarily serves poor children, seniors and the disabled, excluding most other low-income adults.

With an infusion of hundreds of billions of federal dollars, every state's Medicaid program was supposed to open in 2014 to any American making less than about $15,500. The recent Supreme Court decision to uphold the new health care law made that expansion optional for the states.

The guaranteed coverage reflects the belief by many experts that Medicaid, while imperfect, is best positioned to protect a population unable to buy insurance and increasingly shut out of employer-based coverage as businesses drop or scale back health benefits.

Medicaid and the related Children's Health Insurance Program, or CHIP, cover about 70 million people at some point during the year. Half of them are poor children.

Another quarter are disabled or elderly. These beneficiaries are by far the most expensive, accounting for nearly 70 percent of all Medicaid spending, according to the Medicaid and CHIP Payment and Access Commission.