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Michael Petruzzelli

, National Council for Mental Wellbeing

New GOP Health Care Plan Caps Medicaid, Cuts Expansion

September 14, 2017 | Medicaid | Comments
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Four GOP Senators have introduced the latest iteration of health care legislation in the Senate. The bill, introduced by Sens. Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI) revives some of the most troubling elements of previous health care bills, including undermining the Medicaid expansion and imposing a per-capita cap on federal Medicaid funding. The National Council opposes this legislation as it harms Americans in need of comprehensive mental health and addiction treatment services.

The proposal eliminates the ACA’s marketplace subsidies and enhanced match rate for the Medicaid expansion, replacing them with a block grant that would not grow in response to increased enrollment or costs. It also fundamentally restructures the Medicaid program by converting it from an entitlement program to a per-capita cap. Additionally, the legislation expands states’ ability to waive or alter essential health benefits and pre-existing condition protections, potentially opening the door for states to undermine critical types of coverage such as mental health and addiction care. The National Council strongly opposed previous iterations of these proposals when they were introduced in earlier legislation this year.

The authoring senators frame their proposal as one that will give control over health care to the states and allow more creativity to develop systems that reflect their unique populations. As with previous block grant and per-capita cap proposals, in reality states would be left with significantly diminished resources and, in the event a state’s need exceeded this amount, the state would bear 100% of the additional costs. For millions of individuals, these provisions would mean restricted access to Medicaid, restricted access to affordable coverage and restricted access to lifesaving mental health and addictions treatment.


While it seems that the bill faces long odds in winning support of 50 Senate votes – with the Vice President breaking any ties – the National Council takes these discussions and developments very seriously. Majority Leader Mitch McConnell (R-KY) has promised to bring the bill to the floor should the group corral the needed votes. As of Thursday evening, it appears the Senate leadership is supporting the bill and working to gain support before the end of the month. President Trump released a statement on Wednesday applauding the senators for their “solution” to health reform.

Senator Johnson stated he would hold a hearing on the plan as Chairman of the Senate Homeland Security and Governmental Affairs Committee if neither the Senate HELP or Senate Finance Committee do so. Sen. Graham has challenged Republican leadership to throw support behind the bill, as well as advocating for backing from Republican governors.



After weeks of inaction and with just days remaining before the end of the fiscal year, this latest effort for reform constitutes an opportunity to again demonstrate the power and strength of advocates who want to preserve and protect Medicaid. Please continue to join us in uniting for behavioral health and ensuring that every American has the mental health and addiction care they need. Take action here.