"Real liberty is neither found in despotism or the extremes of democracy, but in moderate governments.
Alexander Hamilton

Monday, January 30, 2017

Block grants for Medicaid misguided

Editorial Concord Monitor
Sunday, January 29, 2017

No state stands to lose more than New Hampshire if congressional Republicans led by House Speaker Paul Ryan and Rep. Tom Price, Trump’s nominee to head the Department of Heath and Human Services, go through with plans to block grant Medicaid payments.

New Hampshire’s Democratic congressional delegation can be expected to oppose the change. We urge Gov. Sununu to join Massachusetts Republican Gov. Charlie Baker and others in his party who oppose block grants to the states as well.

As Brendan Williams, president of the New Hampshire Health Care Association warned in these pages earlier this week, the Granite State is the second oldest in the land after Florida. When its huge baby boomer population hits nursing home age it could take first place. That would be bad for the economy and bad for taxpayers.

Historically, according to the Center for Budget and Policy Priorities, when funding for federal programs is block granted, overall federal funding stalls and then gradually falls.

At 50 percent, New Hampshire already gets the lowest possible percentage of federal funding for Medicaid, the health care program that pays for care for the poor, including the poor in public and private nursing homes. New Hampshire is also the only New England state that requires counties, rather than the state, to pay for the nursing home and home care costs of the elderly poor.

Property owners foot the bill through the property tax under a formula that directs more money to counties with a high percentage of elderly poor and a low tax base.

At the Merrimack County Nursing Home, 208 of 286 residents, or 73 percent, are on Medicaid. As federal payments, in real dollar terms, decline, property taxes will rise in a state that already relies more heavily on property taxes to fund government than any other.

Nationally, nursing home costs account for 60 percent of Medicaid spending. Block granting would mean that out of necessity states would have to raise taxes or find ways to cut critical services and pit the needs of the elderly against those of children in low-income families and people with disabilities.

President Trump’s adviser, Kellyanne Conway, the magician of misdirection and information who, with a straight face claimed that the White House was presenting “alternative facts,” claimed that block granting Medicaid would mean that “those closest to the people in need will be administering the program.”

But that’s what happens now. Each state and its employees run the Medicaid program with funding and oversight by federal officials.

Conway also claimed that block grants would cut waste, fraud and abuse. She gave no evidence for that claim because it doesn’t exist.

A reduction of federal funding for Medicaid will affect every New Hampshire resident. Since living at a nursing home can easily cost $10,000 per month, many elderly outlive their resources. Most families have or will have a family member on Medicaid. And all residents, whether they rent or own, pay property taxes.

Republicans have tried to convert Medicaid funding to block grants at least three times in the past. They failed because even some members of their own party recognized that the effort was not about greater efficiency, better care or more local control, it was about money and the desire to minimize federal payments for social welfare programs.

A handful of Republican senators, should they join with Democrats, could prevent the block grant gambit. New Hampshire Republicans, led by Gov. Sununu, should convince as many as they can to do so.

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