Sen. John Hoeven is pitching a provision in a repeal and replacement plan for Obamacare that would allow states to move unused Medicaid dollars to future years.
The North Dakota Republican's plan aims to address some of the concerns that have been raised about changing the structure of Medicaid to a per-capita or block-grant program, as was proposed under the House bill to repeal and replace Obamacare, called the American Health Care Act. While proponents say that those options would give states more flexibility over how to spend their funds, critics have said they worry that the change would result in programs being cut. Under the current Medicaid structure, the federal government matches a certain proportion of spending, which can make budgets more unpredictable but also allows the federal share to coincide with times of economic uncertainty.
"One of the things I'm still talking about and pitching our caucus is that if a state takes the block grant, in a year that they come in under their allotment they can actually get some savings or credit toward a year where they might exceed their allotment," he said in an interview with the Washington Examiner after a working group meeting and lunch with fellow Republicans. "That still gives them an incentive to save and innovate, but then they don't have to worry about getting capped out ... if they have a bad year because they actually can generate some savings to compensate for that."
Hoeven's state expanded Medicaid under Obamacare. The law was originally written so that all states would expand the program to cover low-income people, but a Supreme Court decision made the provision optional. Since then, 32 states and the District of Columbia have opted to expand the program, with some states using waivers to include requirements for premiums or for more involvement of private insurance.
The Senate's repeal bill is being negotiated, but the House version aims to make changes to Medicaid as well as offer people tax credits to buy private coverage. Hoeven said that during the meeting Tuesday, senators discussed the tax credits and how to make sure they would cover people with lower incomes.
"We are looking at how to make sure that Medicaid works for states, for healthcare institutions, as well as the individuals ... and that it dovetails with a more robust, refundable tax credit," Hoeven said. "You want people to be able to buy a policy. So between the two, that's how you help more low-income folks."