❝ The headlines of the Senate Republican bill’s Medicaid overhaul should be familiar by now: It ends the generous federal funding for Obamacare’s Medicaid expansion and places a federal spending cap on the program for the first time.
The cumulative impact: a $772 billion spending cut over 10 years, versus current law, and 15 million fewer people enrolled in Medicaid in 2026.
❝ But the Senate plan also changes the program in subtler yet still important ways. The consequences might not be on the same scale as ending the expansion and capping spending, but they would still be felt by many of the 70 million Americans who depend on Medicaid.
The changes would be made in the name of reducing costs and encouraging work, but they would also make it harder for people to receive Medicaid benefits.
1) Work requirements
❝ …States would be allowed, under the Senate bill, to require Medicaid enrollees to have a job, look for work, or participate in some kind of job training. There are exceptions: Pregnant women, children, the elderly and disabled, and adults caring for kids younger than 6 years old would be exempted.
2) Retroactive eligibility
❝ …Under the current program, when people sign up for Medicaid, they can get their medical care from the three previous months covered retroactively. That’s an important benefit, as many people don’t sign up for Medicaid until they have a medical incident and start racking up bills.
Under the Senate plan, that coverage would be scaled back to the same calendar month that a person enrolled in Medicaid. The new enrollee would be on the hook for any costs accrued before that.
3) Presumptive eligibility
❝ …The Senate bill would repeal presumptive eligibility, prohibiting hospitals from making those determinations and stopping states from enrolling people in Medicaid expansion on a presumptive basis, as Obamacare had allowed.
4) Eligibility redeterminations
❝ Right now, states are required to recheck a person’s Medicaid eligibility once a year. The Republican plan would require that redetermination every six months.
This has a couple of consequences. First, it could more rapidly end the generous federal funding for Obamacare’s Medicaid expansion; under the Senate plan, states lose that enhanced funding if a person cycles off the program for more than a month. More frequent eligibility checks are likely to lead to more people cycling on and off of Medicaid.
Mostly, Republicans presume you’re a crook. After all, they and their peers are crooked, thieving bastards every chance they get. Why should you be any different, eh?
A 14th Century Puritan lack of faith in human beings that some conservatives believe is still ordained by their god.