Republicans Consider Broader Medicaid Changes as They Weigh Its Future

Republicans are eyeing how they can reform Medicaid, and health insurers that offer Medicaid plans want them to look beyond questions of funding and expansion.

A hearing before the Energy and Commerce Oversight Subcommittee Tuesday offered some insight into how lawmakers on a key health care panel want to change the federal program for low-income Americans, such as making it more efficient.

But the hearing offered no details on the biggest question facing Republicans: whether to repeal an Affordable Care Act provision that expands Medicaid, which 31 states and D.C. have signed up for. There was also no clarity on President Donald Trump’s suggestion to use block grants to expand the program’s coverage.

Instead, Republicans focused on narrower issues, such as third-party liabilities, patients who face waitlists to get care, and the misspending of Medicaid funds.

“While we all acknowledge there are serious weaknesses and deficiencies in how this program operates, we also recognize the responsibility of the federal government to provide a safety net to the most vulnerable among us,” said Rep. Tim Murphy (R-Pa.), who chairs the subcommittee. “That means ensuring that taxpayer dollars are spent in a way that actually improves health outcomes and serves the Medicaid beneficiaries in need.”

Another House panel, the Energy and Commerce Subcommittee on Health, is set to consider Medicaid bills on Wednesday that focus on immigrants enrolling in Medicaid, closing annuity loopholes in the program, and clarifying the treatment of lottery winnings.

Health insurers are also pushing lawmakers to consider broader Medicaid reforms, beyond any changes tied to Obamacare, said Jeff Myers, president of Medicaid Health Plans of America. He said the trade group had talked to congressional leaders, key committees and the Trump administration.

“All of them realize that it is frankly a non-sequitur to cut the (federal) money and then leave the program as it exists because that guarantees it will fail,” he said in an interview.

Myers expects the bigger questions, such as how to reform Medicaid rules for nursing facilities, to get more attention in the late spring or early summer.

But dealing with Medicaid expansion must be the first priority in Congress, Josh Archambault, a senior fellow at the Foundation for Government Accountability, said in an interview. States will also have to get involved if Congress decides to go with block grants or per capita caps, he said.

Correction
An earlier version of this report incorrectly stated Archambault’s last name.