Medicaid Block Grants and State-Based Single-Payer

by Reihan Salam

It is important to remember that while it is fair to question whether or not House Republicans have embraced too aggressive a target for reducing the growth of federal Medicaid expenditures, Medicaid block grants have many virtues, among them that they would give states the freedom to experiment with more centralized as well as more market-oriented models for delivering care. Last October, for example, Sarah Kliff of Wonkbook interviewed Monatana’s popular Democratic Gov. Brian Schweizer about his proposal to expand his state’s Medicaid program into a larger public insurance system that would include all Medicaid beneficiaries and all state employees, but that would also be open to all Montanans:


SK: What kind of waivers do you need from the federal government to do this?

BS: The waiver we’d need is Medicaid-related. It would allow us to deliver health care through community health-care clinics as opposed to contracting for specific services, with all kinds of clinics large and small across the state. We’re simply saying that we here in Montana are adults, we have a budget surplus, weren’t good at negotiating and not buying things we don’t need.

SK: Have you looked at other states in pursuing this kind of health reform? I know Vermont is working on a single-payer system that could be somewhat similar to what you’re doing.

BS: Yes, I definitely looked at Vermont, other states. Most of the Republican governors have either asked or plan to ask for a block grant, which is kind of what I’m talking about here. Send me the money and I’ll take responsibility for my Medicaid population. Don’t be my partner anymore.

It would be great to see an odd-bedfellows coalition around granting states more autonomy.

The Agenda

NRO’s domestic-policy blog, by Reihan Salam.