Vox
By: Dylan Scott
Paul Ryan once famously said that he had dreamed about overhauling Medicaid since he was “drinking out of a keg.” But with the news that the House speaker will retire at the end of this year, it appears Ryan will leave Congress without achieving his lifelong ambition. At least not directly. But if you look at the steps the Trump administration is taking to dramatically shrink Medicaid — the nation’s largest insurer, which covers more than 75 million Americans — it’s clear that Ryan’s dreams are alive and well.
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These policies are a remarkable reversal, Medicaid experts say, from the way waivers have been used in the past to expand health coverage. “We’re just talking about ways to cut coverage,” Joan Alker, executive director of Georgetown University’s Center for Children and Families, told me earlier this year. “Under any previous administration, waivers have not been used to devise ways to cut coverage.”
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“Medicaid is supposed to be a joint partnership. But over time, costs kept going up. When that happened, the federal government started to regulate more,” she told reporters a few weeks ago. “If we can get to a place where we say to states: ‘Here’s your money, here are the outcomes we expect you to achieve’ and we have some parameters and guideposts around protections for beneficiaries, and if we can give states more flexibility, that’s what I’d like to get to.”
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