The Deconstruction of the Medicaid Program Act (AKA “Obamacare Repeal”)

Date: March 10th, 2017

Bob Reeg

Act Now to Advocate for Preserving Medicaid

In case you’ve been on media blackout (and who could blame you?), the Republican majority in the U.S. House of Representatives unveiled its long-promised legislation to “repeal and replace” the Affordable Care Act (ACA) on March 6, 2017. Within days of introduction of the American Health Care Act (AHCA), President Trump declared his support and two Congressional committees passed the bill, with their votes split cleanly on party lines. The full House of Representatives may take up AHCA as soon as the week of March 13. The Senate will move thereafter. The dynamics for decision making in the upper chamber differ from the House, so this cake is far from baked.

Top-line provisions of AHCA that are gathering the most attention are those that:

  • Repeal the individual mandate provision of ACA, which requires all Americans to have health insurance.
  • Repeal the subsidy provision of ACA, which provides financial assistance to the subset of Americans not covered by employer or public-provided (such as Medicare, Tricare for military service members, etc.) insurance and who are “too rich” to qualify for Medicaid but “too poor” to obtain health insurance coverage through the individual market with their resources alone.
  • Replace the ACA subsidies (which are targeted to households at lower classes of the income spectrum) with a refundable tax credit (which would be available to all households regardless of their income level).
  • Repeal excise taxes on various components of the health industry, which are a major source of revenue to cover the ACA subsidies.
  • Preserve the ACA requirement that health insurers allow consumers to maintain their young adult children up to age 26 on their family plans.
  • Prohibit health insurers from disqualifying consumers from health insurance due to pre-existing conditions (although insurers could charge these individuals higher rates).
  • Convert the Medicaid program from an entitlement for individuals into a capped program grant to states.

Wait….WHAT…  “Convert the Medicaid program from an entitlement for individuals into a capped program grant to states.”  What the heck is that?

What it is is a monumental “deconstruction” of Medicaid from a program whereby individuals and families below a set income level (usually federal poverty level) and meeting other conditions (such as having a disability, being at elder age, being pregnant, having a dependent child, being a child in foster care) are entitled to a comprehensive package of health services, with costs covered by federal and state funds.  The annual cost of the Medicaid program fluctuates depending on the number of income-eligible beneficiaries, their health conditions, and the health services they utilize.

What the Republican AHCA would do to Medicaid is to convert it to a per capita cap program, whereby the federal government would set a limit on how much to reimburse states per enrollee. States will have to figure out how to cover the rest of the costs of insuring beneficiaries… if they even care to do so. This arrangement could indeed to situations of “too sick… too bad.”

Repeal and replace. Indeed.

Perhaps you were considering sitting on the sidelines with this whole Obamacare repeal because you disagree with the current law, or you personally, your family, or the youth and families your organization supports do not currently participate in the health insurance made available on exchanges because of the ACA.  Alternately, perhaps you have been fired up for months to defend Obamacare at all costs. Regardless of where you stand on the ACA (Healthy Teen Network happens to support it), House Republicans have Medicaid in their crosshairs.  And Medicaid is a linchpin in America’s healthcare system, ensuring that the least of those among us have access to health insurance.

Join us—and many others—in advocating to preserve Medicaid as it stands today. Resources for action include:

March 16 Medicaid Call-In Day—Call your Members of Congress on March 16 and challenge them to preserve Medicaid in its current structure.  You may use 1-866-426-2631 to make your calls.

Anytime—Call or email your U.S. Representative and challenge them to preserve Medicaid in its current structure in legislation being considered to repeal and replace the Affordable Care Act. You may reach your U.S. Representative by calling the Capitol Switchboard at (202) 224-3121 or visiting and finding your representative by typing in your ZIP code.

Resources for learning more about the American Health Care Act, Medicaid, and threats to Medicaid include:

American Health Care Act

House Speaker Ryan–The American Health Care Act: What You Need to Know

Families USA–Talking Points on American Health Care Act

Health Care for America Now–Talking Points on the Republican Bill to Gut the ACA and Slash Medicaid


Kaiser Family Foundation–Medicaid Pocket Primer

U.S. Centers for Medicare and Medicaid Services–Medicaid & CHIP: Strengthening Coverage, Improving Health

Guttmacher Institute–Why Protecting Medicaid Means Protecting Sexual and Reproductive Health

Talking Points: CBO’s Score of The American Health Care Act

Medicaid and Per Capita Grants

U.S. Rep. Brett Guthrie–Democrats’ hypocrisy on Medicaid reform

CLASP–Top Five Ways ACA Repeal and Medicaid Financing Changes Would Harm our Youngest Children

Children’s Defense Fund–Keep Medicaid Strong: Reject Proposals to “Reform” through Block Grant or Per Capita Cap

Center for Budget and Policy Priorities–House Republican Health Plan Shifts $370 Billion in Medicaid Costs to States

Families USA–How Per Capita Caps in Medicaid Would Hurt States

Families USA–Per Capita Caps in Medicaid: Shifting Health Care Costs to the States


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About the Author

Bob Reeg, MPA, CVA, Program Development and Public Policy Consultant, is an accomplished nonprofit organization program director & public policy analyst and advocate, and an emerging social purpose entrepreneur.


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