WASHINGTON, DC – MARCH 7: A copy of the Republican plan to replace the Affordable Care Act is show during a news conference at the U.S. Capitol March 7, 2017 in Washington, DC. House Republicans yesterday released details on their plan to replace the ACA, or Obamacare, with a more conservative agenda that includes individual tax credits and grants for states replacing federal insurance subsidies. (Photo by Win McNamee/Getty Images)
The Per Capita Cap
Anyway, the really upsetting part of Ryan’s proposed plan that I want to draw your attention to is that they are suggesting that a “per capita cap” will be put into place for Medicaid, beginning in 2020.
What this jargon means is that the amount of money the government will pay toward a Medicaid enrollee’s bills will be capped.
This is not how it currently works. Currently, there are no limits on the amount of (covered) care a Medicaid recipient can use. (It’s worth noting that this is how private insurance plans work as well – thanks to the ACA. There are no longer lifetime maximums on healthcare plans, just like there were never any lifetime maximums on Medicaid plans.)
But Ryan and his colleagues want to change that. They want to cap the amount of care the federal government will give a state for each Medicaid recipient to a set amount per person (“per capita”). In other words, you get $500,000 (or whatever) of Medicaid money to spend in the rest of your life. Once you use that up, you’re done.
Maybe you’re thinking that’s not so bad, because you think poor people are lazy. Well, you should know that many Medicaid recipients are not who you think they are.
Sure, low-income adults are on Medicaid. Some of them long-term, many of them short-term. Many of them eventually move onto other coverage – employer or individual. People’s finances change and so do their insurance situations.
But more critically, many disabled or chronically ill people – especially children – are on Medicaid. Kids and adults with disabilities and chronic health conditions often have very high health costs and may not ever be able to work full time. Medicaid keeps those families from going bankrupt. Medicaid allows those children and disabled adults to continue to receive care and stay as healthy as possible. Medicaid keeps them afloat.
Also, many elderly people wind up on Medicaid near the end of their lives. Not many people know this, but Medicare does not include any coverage for long-term nursing care of any kind. *Many* people wind up on Medicaid once they need full-time care, since paying for inpatient nursing care out of pocket is not feasible for all but the ultrarich.
So here’s your take home point on this Medicaid thing:
Sick and disabled children, adults, and elderly people are able to live and die with some degree of dignity thanks to the fact that Medicaid does not have lifetime limits on coverage. Sick kids can have repeated surgeries, years of therapy, and years of medical care without plunging their families into bankruptcy. Elderly people can have a nursing home bed at the end of their lives without bankrupting their kids and grandkids.
No one kicks those sick kids or old people out of the children’s hospital or nursing home when they’ve hit some random dollar amount set by Congress.
Because of Medicaid.
Ryan and his friends, though, are hoping to change that.