I have a piece today at The Washington Post about the history of Republicans trying to gut Medicaid, why they failed, and why they might win this time.
As detailed in a 2013 report by the National Council on Disability (a nonpartisan, federally funded advisory council) on Medicaid block grants and their effect on Americans with disabilities, the first attempt to turn Medicaid into a block grant came in 1981, in Reagan’s first year in office. It made it into a big omnibus budget bill, but was stripped out in a congressional committee. House Speaker Newt Gingrich (R-Ga.) actually got block grants passed in 1995 as part of his “Medigrant” proposal, but President Bill Clinton vetoed it (with strong backing from health policy experts), and it was dropped from the subsequent compromise bill. President George W. Bush and the Republican congresses of 2003 and 2005 could have passed block grants at any time, but sustained resistance from advocacy groups, Democratic leaders such as Rep. Henry A. Waxman (Calif.) and Edward M. Kennedy (Mass.) and the legislative distractions of forming Medicare’s prescription drug benefit kept the bill from advancing.
Moreover, at the time, many Republicans wanted to find bipartisan solutions whenever possible. Henry Claypool, who has been working on Medicaid policy in and out of government since the 1990s, told me that the Deficit Reduction Act of 2005 did include some Republican changes to eligibility, but also expanded support for home- and community-based services in ways that have helped many disabled Americans.
Today, everything has changed. House Speaker Paul D. Ryan (R-Wis.) has been proposing block grants since 2010, but he had no chance to get them enacted under President Barack Obama. Now, he and McConnell have co-opted the legislation intended to fulfill GOP promises to “repeal Obamacare” (which would be bad enough) as a way to sneak through decades-long assaults on the basic American promise of Medicaid.
This time, the phrasing is “per capita caps.”