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Stephanie Pellitt

Policy and Advocacy Associate

Future Uncertain for ACA, Medicaid Under New Administration and Congress

November 17, 2016 | Federal Budget | Medicaid | Comments
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The Republican sweep of the White House and both chambers of Congress in last week’s election means big changes could be coming to the Affordable Care Act and Medicaid. President-Elect Donald Trump and GOP Congressional leaders ran on a platform to “repeal and replace” the ACA and plans to rein in spending for Medicaid. Both proposals could have a potentially devastating effects for both consumers and providers.

Plans to scale back the ACA and block grant Medicaid funding are longstanding Republican priorities. As has been written previously in Capitol Connector, these proposals could result in reduced eligibility for health insurance, reduced availability of health care services, and lower reimbursement rates for providers. However, it is important to be clear that little is known, right now, about what health care reforms President-Elect Trump and Congress will pursue and what mechanisms will be used to achieve them. Proposals thus far have focused on:

  • Converting Medicaid to a block grant. Medicaid is currently funded through an open-ended federal-state matching formula. Republican proposals to change federal Medicaid funding into a lump-sum annual block grant have existed for over 25 years. More recent proposals have also been paired with increased state “flexibility” to design benefits, limit eligibility, increase beneficiary cost sharing, and enact other administrative reforms.
  • Converting Medicaid funding into per capita caps. Another option to redefine Medicaid funding, similar to a block grant, is a per capita cap. Under this proposal, states would be given a set amount of money per enrollee, which would increase each year. Again, this proposal is designed to provide states additional flexibility, but could in fact have a detrimental impact on the state’s ability to provide services for those in need.
  • Repealing the Affordable Care Act. While the ACA has extended health coverage to millions of Americans, the law remains unpopular in conservative circles with Republican Congressional leaders calling for its repeal. Speaker of the House Paul Ryan’s (R-WI) “A Better Way” white paper is expected to be the foundation of a conservative “repeal and replace” package. Speaker Ryan’s plan would end the federal contributions to Medicaid expansion and exchange subsidies, and be replaced by proposed refundable tax credits for individuals without access to employer-based or public coverage. His plan also proposes to leave intact some of the key elements of the ACA, including the requirement that insurers can’t deny coverage based on pre-existing health conditions and the ability for young adults to stay on their parents’ insurance plan.


For a more information on the implications of the national elections on access to care for persons living with addiction and/or mental illness, please join the National Council for a post-election update webinar on Thursday, December 15, 2016 at 1:00 p.m. ET. The webinar will detail initial reactions inside the Beltway as well as opportunities our community will have to affect change in the coming months.



The National Council will be covering any possible threats to the Medicaid program in great detail starting in January when the new Congress begins. Join us for biweekly webinars that will dive into the Medicaid proposals on the table as well as opportunities to advocate for individuals living with addiction and mental illness. Scheduling and registration details are coming soon.