Talk about converting Medicaid to "block grant" program is on the rise, and I think is a real possibility independent of the repeal & replace quest. With a block grant, the feds would give states a fixed sum, indexed to some inflation factor. This change in financing would tighten the budget constraint for states, and possibly make states less able to cover people (if they run out of money) or less willing (since the marginal dollar would come from the state, rather than a state-fed blend).
Potential upsides to a block grant are that it could create flexibility for innovation and shift away from some of the more arcane legacy configurations of Medicaid that we have today. (Could be nice to address social determinants of health!) The major worry is that medical spending rises faster than general inflation, and over time this could result in massive cuts to the program. I'm of the mind that 1332 waivers could be used for the 'innovation' path, and I worry that block grants are a blunt way to slash the social safety net. Health needs wouldn't go away, so we'd have to pay one way or another for uncompensated care.
What changes would you make to Medicaid, if you could?
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