7 Questions Congress Should Answer Before Messing with Medicaid

Ok, all you Schoolhouse Rock fans, let’s sing along:

I’m just a Bill. Yes, I’m only a Bill.

And I’m sitting here on Capitol Hill.

Well, it’s a long, long journey to the Capital City

It’s a long, long wait while I’m sitting in committee.”

That was true in 1976, when Bill made his debut. But today is 2017, and things are different. Very different. In the “Capital City” these days, leaders are taking a sharp detour from regular order and seem intent on ramming legislation through without much thought about its impact on children and families. Some legislation doesn’t spend much time in committee or receive the scrutiny it should.  It just blows through. No hearing. Slam-dunk markup. And warp-speed passage through the House and Senate before landing on the President’s desk for signature.

That, at least, is the current intel on the plans that Republicans in the House have for passing the “repeal and replace” legislation that they and the President have promised us. (Things are somewhat unsettled, so it’s possible that this intel will change by the time you read this blog, but let’s reflect on this scenario for now).

What is particularly breathtaking about this fast-track process is that this bill is not just about designating a day in honor of a dignitary or changing the name of a post office. It’s not even just about “repeal and replace.” It’s about setting a limit on the amount the federal government will pay states for delivering Medicaid services to 33 million children, 28 million parents and other adults, 10 million individuals with disabilities, and 6 million seniors. It’s hard to imagine a more fundamental or disruptive change to this pillar of our nation‘s health care system, a program that has been a lifeline for children, families and communities for over 50 years.

In the good old days, committees were where new laws got their start after careful study and deliberation. Committee members had expertise in the issues assigned to them, and they used that expertise to improve the bills that they recommended to their colleagues for consideration on the floor of the House and Senate. To inform themselves about particular bills, they held hearings, gathered input from Congressional support agencies and stakeholders on the intended and unintended consequences of the proposal before them.

How quaint. If the current intel is correct, the members of the House Energy and Commerce Committee, where the Medicaid changes will be considered, will not have the benefit of even one hearing on the Cap Medicaid and Repeal and Replace the ACA bill before marking up legislation as early as next week. They will not even hear from what their own agencies with Medicaid expertise – the Congressional Budget Office, the Government Accountability Office (GAO), and the Medicaid and CHIP Payment and Access Commission (MACPAC) – have to say.   And neither will the rest of us.

That leaves it to us to do our own research. Here are some basic questions that we – and our Representatives – should have answers to before this proposal moves one step further in the legislative process:

  1. Medicaid is the nation’s largest health insurer for children. Thirty-three million children rely on Medicaid/CHIP for health care coverage. How many of them will lose their guarantee of coverage under the proposal to cap federal Medicaid funding to states?
  1. Medicaid is the nation’s largest health insurer for kids with disabilities or other special health care needs, covering 43% of them. How will capping federal Medicaid payments to states affect their guarantee of coverage? How would the loss of coverage affect their health and their families’ economic security?
  1. Medicaid is the nation’s largest insurer for births, covering about 48% of newborns to ensure a healthy delivery and strong start during their critical first year of life. If federal Medicaid payments to states are capped, will pregnant women and new mothers and their babies still have a guarantee of coverage?
  1. Medicaid offers a child-centered benefit package (EPSDT) that covers all of the screenings and treatments recommended by pediatricians. If federal Medicaid payments to the states are capped, what will happen to these benefits and the children whom rely on them for their healthy development?
  1. If the federal government caps Medicaid payments to states, will children covered by Medicaid be able to keep their doctors and continue to be cared for by their local hospitals?
  1. Medicaid provides the lion’s share of federal funding flowing into state treasuries. How much will capping federal payments to states cut from my state’s federal revenues? How much will those cuts limit my state’s ability to keep children and families covered?
  1. How will a federal Medicaid funding cap impact centers of excellence such as children’s hospitals, teaching hospitals, or specialty providers like the Cleveland Clinic or Mayo Clinic? Will they be able to continue serving as community resources to children and families?

Bill, who is just a Bill, doesn’t like to sit in committee, and who can blame him? But Medicaid’s is a big deal for our nation’s children and families. Even Bill would want to be sure that committee members take the time to think this one through. These 7 questions are as good a place as any for Members of Congress to start examining this radical plan to restructure Medicaid.










Andy Schneider is a Research Professor at the Georgetown University McCourt School of Public Policy.