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Michael Petruzzelli

, National Council for Mental Wellbeing

Republicans Unveil Health Care Plan, Legislation Likely Next Week

February 23, 2017 | ACA | Medicaid | Comments
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Late last week, Congressional Republicans released a policy document detailing their vision for repealing and replacing the Affordable Care Act. The proposed plan includes rolling back Medicaid expansion and restructuring Medicaid into a block grant or per capita cap system while offering tax credits to stabilize the individual insurance market. It is expected that a formal bill will be introduced in the House Energy and Commerce Committee when Congress returns from recess next week.


Under this proposal, Congress would allow states that expanded their Medicaid programs to continue receiving the enhanced federal match payments for a limited period of time. However, at the end of this allotted time, states that choose to maintain the expanded Medicaid population would be reimbursed at the traditional payment rate for eligible beneficiaries. The proposed plan would offer non-expansion states “additional temporary resources for safety-net providers during this period of time.” No details are yet available on what these additional resources might look like or which providers might see additional support.

Research has shown that single adults with mental health and addiction disorders are the single largest beneficiaries of Medicaid expansion. This National Council fact sheet details the crucial role Medicaid expansion plays in providing access to treatment services across the country. Advocates are invited to share this document with legislators and staff as they work to stave off these potential life-threatening reforms to the Medicaid.


Based on Speaker of the House, Paul Ryan’s plan titled, A Better Way, the draft proposal of repeal and replace would allow states to decide whether they receive federal Medicaid funding via per capita payments or a block grant. The policy idea is said to allow states greater flexibility and more opportunities to better cater the program to individual state needs. The current plan details four major beneficiary categories – aged, blind and disabled, children, and adults – that would be the basis of calculating each state’s total per capita allotment. In contrast, under a block grant, each state would receive a single lump sum payment for the year.

Both a per capita cap and a block grant scenario are structured to limit federal Medicaid spending over time and grow at a slower rate than current Medicaid program growth. This shrinking federal investment in Medicaid would put already cashed-strapped states on the hook for any enrollment fluctuation or increased enrollee health needs in Medicaid. Past experience has shown that when faced with a budget deficit, states often turn to reductions in eligibility, provider payments or benefits to close the gap.


News out of Washington suggests that a repeal and replace bill could be introduced as soon as next week when Congress returns from recess. From there, the House of Representatives will likely engage in a series of committee hearings, giving advocates plenty of opportunities to influence the discussion and help protect Medicaid from these dangerous reforms. Looking to get involved? Click here and join the National Council’s Unite4BH campaign!