The Washington PostDemocracy Dies in Darkness

Opinion The Trump administration’s cruelty knows no limits. Here’s the latest.

President Trump with Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, in Washington on Jan 16. (Jabin Botsford/The Washington Post)

When President Trump and Republicans in Congress failed in their 2017 attempt to repeal the Affordable Care Act, it was in no small part because repeal would have wiped away the ACA’s expansion of Medicaid. They probably believed that it wouldn’t be such a big deal. After all, it’s a program for poor people, right? Who cares about them?

What they found out, through an outpouring of protests and angry responses from constituents, was that Americans care quite a bit about Medicaid. There are now more than 71 million people on Medicaid and its subsidiary, the Children’s Health Insurance Program (CHIP). Medicaid is overwhelmingly popular, and nearly all of its recipients like it.

Repealing the ACA would have kicked 15.4 million Americans off their Medicaid and CHIP coverage, according to one analysis. And when they couldn’t do it through legislation, the administration supported a preposterous lawsuit filed by Republican-led states in hopes that the Supreme Court would do it for them (it’s still pending).

But failures and delays have not quenched the Republican thirst to kick people off Medicaid. So Wednesday, the administration announced that it is allowing any states that want — i.e., states run by Republicans — to take a sledgehammer to Medicaid.

They’ll do this primarily by converting it a “block grant” from its current status as an entitlement. The way an entitlement works is that the program’s budget is not capped; if, in December, a new person applies and they qualify, then they’re entitled to coverage. Under a block grant, that would no longer be true; the state would get a block of money, and if it runs out, too bad. Politico’s Dan Diamond and Rachel Roubein explain what the administration is doing:

The forthcoming block grant program comes with a new name — “Healthy Adult Opportunity” — but retains the original mission long sought by conservatives: allowing states to cap a portion of their spending on Medicaid, a radical change in how the safety net health program is financed.
The block grant plan, which invites states to request capped funding for poor adults covered by Obamacare’s Medicaid expansion, also would let states limit health benefits and drugs available to some patients.

So states would be allowed to turn away qualified applicants, limit health benefits and deprive people access to medications they need. That’s “Healthy Adult Opportunity” in the same sense that if I shoot you in the kneecap, I’ve given you “Mobility-Enhancing Pain Relief.”

This is not just a radical change to the program, it’s absolutely villainous.

Block-granting has long been a conservative goal, but Seema Verma, whom Trump named to run the Medicare and Medicaid programs, has taken to it with a particular relish. Verma has made no secret of the fact that she’d like to have as few people getting Medicaid as possible, and every time someone loses their coverage, as far as she’s concerned, it’s a victory.

“This policy is about helping people achieve the American Dream,” she said about the work requirements the administration pushes — which don’t actually help anyone get work but do force them to navigate a bureaucratic maze, and then snatch away their coverage if they fill out the wrong form or don’t file a time sheet on time.

“People moving off of Medicaid is a good outcome because we hope that means they don’t need the program anymore," Verma also said.

I don’t know whether she actually hopes that, but her immediate priority is to kick people off — and, remember, we’re talking about some of the most vulnerable people in our society, who are unlikely to be able to afford private insurance that gets more expensive every year.

We can’t know what the future of the ACA is (though my suspicion is that knowing what a catastrophe it would be for the Republican Party if they actually succeeded in their lawsuit, Chief Justice John G. Roberts Jr. will step in and vote with the liberal justices to save his party from itself). But we can be sure that every day this administration is in office, it will try to take health coverage away from as many Americans as it can.

Read more:

Greg Sargent: Have Republicans lost the argument over the Medicaid expansion?

Greg Sargent: Medicaid expansion keeps breaking through in red America. Next stop: North Carolina?

Jared Bernstein: Life and death ... and Medicaid

Brent Merritt: Virginia’s Medicaid work requirements are puritanism run amok