Kellyanne Conway denied that the Republican health-care legislation cuts Medicaid, saying instead that it slows the program’s growth. Jon Greenberg of PolitiFact says the claim is “mostly false” because the legislation rolls back eligibility for Medicaid. But PolitiFact has its facts wrong.
Here’s how Greenberg describes the Senate bill’s changes to Medicaid.
The Senate bill takes several steps to restrain Medicaid spending.
It rolls back who is eligible. Before Obamacare, Medicaid covered low-income children, pregnant women, elderly and disabled individuals, and some parents, but excluded other low-income adults. Under the Affordable Care Act, 31 states and the District of Columbia exercised the option to make Medicaid available to anyone making up to 133 percent of federal poverty. For a family of three, that would be about $27,000 a year. The Senate bill eliminates that option as of January 2018.
This shuts out the Medicaid option for over 2.5 million people in states that didn’t expand eligibility.
The bill also makes federal payments to expansion states less generous. Under Obamacare, Washington covers at least 90 percent of the cost of covering people in the expansion group. That’s a better deal than the regular match, which can be anywhere from 50 to about 70 percent. The Senate bill phases out the higher rate for expansion states and by 2024, the match falls back to the regular rate.
The bill further ends Medicaid’s days as an open-ended promise to cover a certain percentage of a state’s costs. Instead, the bill shifts the program to a capped amount. The cap might apply on a per-person basis, or states might opt to take their money as a block grant. In either case, the amount would rise each year, but using a lower inflation factor than is used today.
According to PolitiFact, then, the Senate bill does three things to Medicaid: It rolls back the eligibility level, cuts the match rate, and imposes a cap on federal payments to states per beneficiary. It’s that first change that Greenberg cites to justify his “mostly false” rating. And that first change isn’t in the bill.
States that didn’t expand Medicaid eligibility — which, by the way, they could do up to 138 percent of the poverty level, not 133 percent, as Greenberg says — will remain able to do it. Under the bill, the federal government will pick up more than half the cost for states that choose it. It just won’t cover 90 percent of it. The CBO says that as a result of this reduced match rate, none of the non-expansion states will take up the federal offer to expand their Medicaid programs. Maybe that’s true and maybe it isn’t. But Greenberg is just wrong about the eligibility question on which he puts so much stress.