EDITORIAL: What all 50 Medicaid directors know about Cassidy-Graham

Akron Beacon Journal (OH)

Sept. 25--U.S. Sen. John McCain proved decisive again. On Friday, the Arizona Republican announced that he would oppose the latest attempt to repeal the Affordable Care Act. He cited the flawed process, rushed, lacking bipartisanship and a Congressional Budget Office assessment of its impact.

Over the weekend, the position of the Senate Republican majority further weakened as others joined the opposition or moved closer to where McCain stands. Yet as politically significant as this movement is, another group took a more telling policy stand last week. All 50 state Medicaid directors, from Republican and Democratic administrations, voiced their opposition to the Cassidy-Graham legislation.

They described the measure, sponsored by U.S. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, as "the largest transfer of financial risk from the federal government to the states in our country's history."

Put aside the absence of sufficient hearings, debate and analysis. What is known is bad enough, especially for states.

Cassidy-Graham would end the Medicaid expansion and the subsidies to help low- and moderate-income individuals buy insurance on their own through the online exchanges. States would receive smaller block grants instead, leaving them to shrink benefits. Most likely, states would abandon the efforts entirely as the block grants expire in 2027.

Might Congress extend the block grants at that point? Recall that the funding would require offsetting savings, making the task more formidable for lawmakers.

To be sure, states that have not expanded Medicaid would gain in the short term, as federal funds are directed their way from states, such as Ohio, that have adopted the expansion. Eventually, all states would take a financial hit because federal funding for Medicaid would be cut and capped, at levels below projected increases in health care costs.

That translates to states looking to cover shortfalls in funding, the Center on Budget and Policy Priorities putting the reduction at $1.1 trillion from 2020 to 2036. Those at risk in Ohio include nearly 1 million children receiving Medicaid, plus three in five nursing home residents and 150,000 Ohioans getting treatment for opioid addictions.

Add to the fiscal challenge that Cassidy-Graham would make it harder for states to raise revenue to support Medicaid. As the Center on Budget and Policy Priorities notes, the measure would restrict the way states tax health care providers.

So, for all the talk about states gaining new flexibility, they actually would face less room to move, their budgets already strained, requiring choices, say, between public schools and health care. That gets to the worries of Medicaid directors, states without the resources to invest adequately in people or for the future. It helps explain the mounting opposition to the Cassidy-Graham proposal.

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