Republicans generally believe, much like the 10th Amendment, that state action tends to be more prudent than federal action where federal action is not explicitly prescribed in the Constitution.
For that reason, the Republican healthcare bill seeks to return the administration of Medicaid services to the states by giving them a set amount of money and allowing them to spend where they deem necessary. This assumes that states have a better, more localized understanding of what their recipients need and how money can best be spent than does the federal government.
Sen. Tim Kaine, R-Va., does not believe that. He tweeted on Wednesday: “Over 600,000 kids in Virginia rely on Medicaid services. I’m standing up against #TrumpCare for them & their families.”
Let’s parse it: By enumerating the children and promising to stand up against the bill, Kaine implies that the Republican bill, if passed, would take away or seriously jeopardize the children’s coverage protections. But children would be threatened only if states decided to stop covering them, which certainly wouldn’t fly.
Perhaps Kaine read this analysis by Dylan Matthews of Vox: “States would no longer be required [under the Republican bill] to cover poor parents. They could charge unlimited premiums, deductibles, and copayments. They could impose enrollment caps and waiting lists, and they could cut the range of services provided to poor children.”
Matthews is right. Block granting federal money to states, as the bill does, would remove many of the strings attached to federal money, but does that mean that states would necessarily stop covering poor parents or start charging exorbitant premiums? They could, but would they?
Matthews and Kaine assume the reason states use federal Medicaid spending for children and the poor is because Washington forces them to do so, which assumes the worst of states.
Medicaid is an unsustainable program and it needs reforms. Republicans have offered a solution in their bill, believing that states are better arbiters of care for their poor than the federal government. The only way the Better Care Reconciliation Act jeopardizes children, as Kaine implies, is if states go rogue and start pocketing federal Medicaid money. I see no reason to believe that would happen.
