WASHINGTON, DC (October 19, 2017)— A commentary published today in The American Prospect says that the Trump Administration plans to use its discretionary authority over Medicaid demonstration projects to cut eligible people from the Medicaid rolls, thus weakening this crucial safety net program from within.
“Medicaid’s irreplaceable value as a safety net that is accessible when help is needed most becomes clear when catastrophic events strike or when health threats such as the Zika virus suddenly wash over entire populations,” says commentary author Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at the George Washington University’s Milken Institute School of Public Health (Milken Institute SPH). “If the Administration is successful in their goal, the nation would be left with a weakened public health program, one that has successfully worked behind the scenes for decades to help keep millions of Americans healthy.”
Rosenbaum’s commentary says this year’s attempts to repeal or replace the Affordable Care Act sought to impose severe long-term cuts in federal Medicaid funding. She goes on to say that the threats are not over yet.
The commentary says that even without Congressional action the administration has considerable power to modify Medicaid as long as its actions are consistent with Medicaid’s statutory objectives. “From all indications however, the administration intends to bypass the basic requirement that it use its power to promote Medicaid’s purposes, not destroy them, by withdrawing Medicaid coverage from many who depend on it,” says Rosenbaum.
In what Rosenbaum calls a “jaw-dropping” letter to the nation’s governors, former Health and Human Services Secretary Tom Price and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, encouraged states to impose work requirements as a condition of eligibility through Medicaid demonstration projects. “Their letter offered no explanation as to how introducing roadblocks to coverage would further Medicaid’s objectives.” Rosenbaum goes on to point out the unreasonableness of work requirements in areas of the country “where jobs are scarce, especially for people with disabilities and other health problems.”
The commentary adds that Medicaid demonstration projects provide an essential proving ground for ways to improve this enormously complex health program. “Opinions can differ about how far states should be able to go in combining program improvements with operational constraints; this type of balancing act is an inherent element of many social-welfare demonstrations,” Rosenbaum says. “But when high government officials state from the onset that their goal is to overturn an act of Congress, the question is not whether they are making the right trade-offs but whether they can be held accountable for violating the law.”
The commentary, “Weakening Medicaid from Within: The Trump administration is poised to misuse its legal authority in an effort to cull people from the Medicaid rolls,” appears online today and in the fall issue of The American Prospect.