No Easy Choices: 5 Options to Respond to Per Capita Caps

Congress is debating the American Health Care Act (AHCA) that would end the enhanced matching funds for the ACA Medicaid expansion and would also end the program-wide guarantee for federal Medicaid matching dollars by setting a limit on federal funding through a block grant or per capita cap.  Under a block grant, federal spending would be limited to a pre-set amount.  States could cap enrollment or impose waiting lists as mechanisms to control costs.  Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps.

Faced with restrictions in federal financing, states would have to make hard choices. Research shows that there is not strong evidence to support large savings through options aimed at achieving Medicaid efficiencies. Under a block grant, states could cap or limit enrollment; however, the incentives and options under a per capita cap could be different.  This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap:

Kaiser Health Tracking Poll – June 2017: ACA, Replacement Plan, and Medicaid

  • As the Senate prepares to hold a vote on a plan to repeal and replace the Affordable Care Act (ACA), a majority of Americans say they have an unfavorable view of the plan (55 percent) while three in ten have a favorable view. In the past month, support for the replacement plan has decreased among Republicans (from 67 percent in May to 56 percent currently) and among supporters of President Trump (from 69 percent to 55 percent).
  • Over the past year, Kaiser Health Tracking Polls have found a modest increase in support for the ACA and this month’s poll finds about half of the public (51 percent) expressing favorable views of the ACA while 41 percent hold an unfavorable view. This is the first month that favorability has tipped over the 50 percent mark since Kaiser Family Foundation began tracking attitudes on the law in 2010 and continues the trend found last month with the public more favorable towards the ACA than the replacement plan (51 percent vs. 30 percent).
  • Large shares of the public overall, and majorities across parties, support the federal government’s role in prohibiting health insurance companies from charging individuals with pre-existing conditions more for their coverage and requiring health plans to cover a certain set of benefits, while fewer would want to turn these decisions over to the states.
  • Few Americans, regardless of party identification, say repealing and replacing the 2010 Affordable Care Act should be the “most important priority” for President Trump and Republicans in Congress (7 percent of Democrats, 9 percent of independents, and 8 percent of Republicans). Another two in ten (22 percent) say it is “very important but not the most important” priority. Republicans are much more likely to see repealing the ACA as a very important or top priority (50 percent) than Democrats (18 percent) or independents (28 percent).
  • The majority of the public – regardless of partisanship – hold favorable views of Medicaid, the government health insurance and long-term care program for low-income adults and children. Three-fourths (74 percent) of the public say they have a favorable view of the program, including four in ten (37 percent) who have a “very favorable” view. In addition, six in ten say the program is working well for most low-income people nationally (61 percent) and seven in ten say the program is working well for most low-income people in their state (67 percent).
  • When asked about proposed changes to the Medicaid program, a majority of the public support allowing states to impose work requirements on non-disabled adults (70 percent) or drug testing as a condition of enrollment (64 percent). However, fewer support changes that would cut funding or alter the funding structure. For example, about one-third support reducing funding for Medicaid expansion or limiting how much money each state gets from the federal government each year.
  • The public is more likely to blame health insurance companies rather than the actions of the current or previous administration for insurers deciding not to sell insurance in certain ACA marketplaces. About four in ten (42 percent) say the problems are mainly due to profit-driven decisions by health insurance companies while fewer say the problems are due to either the way the law was designed by the Obama administration and Democrats in Congress (28 percent) or uncertainty brought on by the actions of President Trump and Republicans in Congress (22 percent).

Conflicts of interest in health care journalism: VIDEO with our publisher about “an unhealthy state of things” (Part 3 of 3)

In the past two days, we’ve outlined a number of concerns about news organizations, professional journalism organizations and academic institutions that are involved in health care journalism reporting or training while accepting sponsorship or funding from health care industry entities that are often subjects of what the journalists or trainees do or will write about. (Part one of series. Part two.) These practices may be good for corporate, organizational or academic institution coffers, but the sponsorship comes at a price – of potential damage to journalism’s integrity and to the public trust in journalism, news reports and news organizations.

We have touched on examples of our concerns involving:

  • The World Conference of Science Journalists
  • The Association of Health Care Journalists
  • The University of Colorado
  • The University of Kansas
  • The National Press Foundation
  • NPR, STAT,

Ben Bagdikian, journalist/educator/media critic, wrote to and about journalists:

“Never forget that your obligation is to the people. It is not, at heart, to those who pay you, or to your editor, or to your sources, or to your friends, or to the advancement of your career. It is to the public.”

In this final part of our three-part series, I talk about some of these issues in more depth, and from the perspective of my growing concerns over a 44-year career in health care journalism.