Ryan health care proposal gives Medicaid to states

Matt Pommer • Wisconsin Newspaper Association

House Speaker Paul Ryan has issued a Republican prescription for America’s health finances just in time for GOP election campaigns.

It’s the long-promised alternative to Obamacare. It’s loaded with goodies and controversies, including a bigger role for state governments.

Ryan’s proposal includes phasing in an age 67 start for Medicare. It would eliminate Obamacare mandates for employers providing coverage and individuals getting health insurance.

Some popular insurance ideas like allowing children to stay on their parents’ policies to age 26 and providing insurance options regardless of health condition would be maintained.

Alas, there was no indication of how it might be financed. The devil is always in the budget details.

Eliminating Obamacare would assuredly lower or eliminate the so-called “Cadillac” excise tax of 40 percent due to go into effect in 2018 on health plans whose value is more than $10,200 for individual coverage and $27,500 for a family.

The tax would be applied on amounts above those thresholds. While the Republican-controlled Congress has repeatedly voted to repeal Obamacare, it lacks the votes to override a veto.

The plan contains several favorite Ryan ideas, such as encouraging competition between Medicare and private health insurance programs, and Medicaid block grants for each state.

On Medicaid, individual states could require able-bodied persons to work; waiting lists or enrollment caps would be possible in certain categories, and premium requirements could be implemented.

States would get block grants for Medicaid, leaving them to solve the difficult detailed questions involved in health care and insurance.

That’s kicking the health-policy can down the street to the 50 state capitols.

An aging America and medical advances have complicated the financial issues surrounding health care. Wisconsin already is experiencing tough issues in providing services to the frail elderly and disabled citizens.

Some 60,000 persons are in those categories, and the spending takes about 40 percent of the state’s Medicaid spending.

The Walker administration this year proposed having forprofit companies bid to provide a complete array of services to them. The state would have been divided into three service areas.

Republican senators on the Joint Finance Committee balked at using for-profit companies to provide the care and services necessary to limit institutional care of these individuals.

The Walker administration has withdrawn the idea – at least in an election year.

“Wisconsin has one of the best long-term care systems in the nation, and we want to keep it that way,” said Tom Frazier co-chair of the Long Term Care Coalition. Frazier was executive director of the Coalition of Wisconsin Aging Groups from 1983 to 2010.

“I don’t think it (going to private companies) is over. There will be more to come,” said Frazier.

“It is unfortunate that people are playing politics with the future care of our most vulnerable citizens,” he added.

The Walker administration’s proposal and its later withdrawal in the face of Republican legislative opposition indicates that letting the states decide how to spend federal Medicaid grants would be difficult.

It is a huge program, and the aging population indicates it will continue to grow.

Medicaid and related programs took 70 percent of the new state tax dollars in the current biennium, according to State Rep. John Nygren, R-Marinette, co-chair of the Legislature’s budget committee.

“Medicaid is the single largest cost-driver in our state budget,” he said.

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