The case against Medicaid block grants

The case against Medicaid block grants

President Donald Trump is proposing to give states new authority to receive their federal Medicaid funding as a single “block grant.” This initiative, announced last week, abandons Medicaid’s historic commitment to quality, affordable care for low-income people and creates new financial risks for states. The administration’s guidance marks its latest step in its effort to end the Affordable Care Act’s Medicaid expansion to low-income adults and weaken coverage for other vulnerable groups. The Center on Budget and Policy Priorities explains:  

States with block grant waivers could deny coverage for prescription drugs, allow states to impose higher copayments on people in poverty, and waive standards for managed care plans (which many states use to provide Medicaid coverage). Moreover, capped federal funding would shift financial risk to states, with federal funding cuts most likely to occur when states can least absorb them — such as during recessions, public health emergencies, and other times when states face both high demand for coverage and strain on other parts of their budgets.

The consumer healthcare group Community Catalyst also inveighed against the new guidance, as did several other national healthcare organizations: 


Fact-free decision-making at the USDA
Recently, the U.S. Department of Agriculture has cast aside facts and data in favor of anecdotes and ideology when making major decisions. Politico’s Ryan McCrimmon explains how the department overlooked or ignored key information when deciding how many children would lose automatic access to free school lunches under a proposal to change eligibility requirements for the Supplemental Nutrition Program. The agency similarly stumbled when estimating how many people would be affected by a new rule that  restricts states’ ability to provide food benefits to childless adults living in high-unemployment areas who are struggling to find a steady job.

When USDA rolled out a proposal in July to crack down on eligibility for food stamps, there was a key figure absent from the Trump administration’s formal analysis of the rule: how many low-income kids would lose automatic access to free school meals. Lawmakers hounded USDA officials for months to track down those figures, which turned out to be twice as high as USDA initially indicated. “The fact is that [the recipients] are a complicated group of people on which we have little data … yet USDA has done no research on how this new rule will impact these vulnerable Americans,” [Rep. Jim] McGovern said after the final rule was published in December. The Trump administration ought to know more about this population before they literally take food off their table.”


Mixed news on commutations
Since taking office in 2016, Gov. John Bel Edwards has commuted 34 sentences for people convicted of violent crimes. That’s a sharp increase over his predecessor, Bobby Jindal, but considerably fewer than several of his other predecessors. The issue is particularly important in Louisiana, where harsh sentencing laws for violent offenders make it the only chance that many convicted criminals have of ever seeing freedom. The Advocate’s Lea Skene and Sam Karlin

“Commutation powers have been weaponized politically … but these are old narratives, and more people are starting to see understand that clemency is there for a reason,” said Kerry Myers, deputy director of the Louisiana Parole Project, which helps former state prisoners re-enter society. “When the sentencing structure doesn’t allow for redemption or discretion, that’s where this process comes in.”


Career and technical education on upswing
Louisiana has seen a resurgence of career and technical education, with the number of industry-based credentials issued to students increasing by about 72,000 in the last six years. At the center of this surge is the Jump Start program, a high priority for former state education superintendent John White. Supporters of the program said a key to its success was changing the narrative around students who don’t go to college, who were often looked down upon for their decision. The Advocate’s Will Sentell

Under new state rules, career and technical education students will be eligible to be named student of the year. Those who pursue post-secondary training in construction will be eligible for $1,000 scholarships, with up to 40 per year offered. … “We have about 15% of the population with a college degree in St. James,” he [Troy Borne, lead Jump Start teacher at the St. James Parish Career and Technical Center] said. “So what do we do with the other 85%? We have to close that gap, get people qualified and create a work force to serve the industry coming to St. James.”


Number of the Day
13.4% – The percent of pregnancy-related deaths in Louisiana from January 2016 through December 2017 that were homicides. Pregnant women in Louisiana are more likely to be killed than to die from any single pregnancy-related condition. (Source: JAMA Pediatrics via The Advocate)