As the presidential campaign trail heats up, Republican candidates are fleshing out more details on their health care proposals. While Obamacare replacement seems to be a top priority for most of the Republican field, candidates are also talking more about their plans to control entitlement spending by cutting Medicaid costs.

In August, Wisconsin Governor Scott Walker and Florida Senator Marco Rubio outlined their Obamacare repeal/tax credit replacement plans. On the entitlement front, both candidates also proposed to cut Medicaid spending by imposing caps on the amount of federal funding that would be available to states to pay the cost of covering their lowest income citizens. Earlier this spring, New Jersey Governor Chris Christie also promoted such a capped Medicaid allotment – a Medicaid per capita cap — as his preferred method to tackle “unrestrained growth” in Medicaid spending.

While reining in runaway entitlement spending might make for good campaign trail rhetoric, the reality is that such a plan would dramatically increase financial risk for states and could lead to huge disruptions in coverage for our most vulnerable populations who rely on Medicaid the most – poor kids and elderly Americans. Unlike the current system where the federal government provides support to states to cover the cost of each eligible enrollee, under a per capita cap states would be provided a fixed amount of federal support. If state spending exceeds the amount provided by the feds, governors would have to make up the difference. In times when the federal amount falls short of the actual costs, they would have no choice but to make significant changes in their Medicaid programs to make up for the loss of federal dollars. This would mean changes to who is eligible for Medicaid, increases in out-of-pocket costs to families for services, reductions in benefits and services that are available to Medicaid enrollees, and cuts in payments for providers that provide services.

It’s not just the candidates who are entertaining per capita cap proposals, Sen. Orrin Hatch (R-UT) and Rep. Fred Upton (R-MI), chairmen of the Senate Finance and House Energy and Commerce Committees, have authored proposals to cut Medicaid by capping federal funding through a block grant or per capita cap.

Given the disastrous implications of Medicaid per capita caps for states it’s hard to imagine that governors would agree to take on the risk that goes along with capping their federal Medicaid allotments. However, as more and more candidates look to this policy as a solution to control Medicaid spending advocates for children and the poor should consider themselves officially on notice. It is clear that Republicans on the campaign trail and in Congress are fine-tuning their proposals to restructure Medicaid and they will be ready to move when the time is right. These are complicated issues and advocates for children and the poor must do their homework so that we are ready to counter the attack on Medicaid whenever it comes, in whatever form it comes.

As I discuss in our latest fact sheet, Medicaid Per Capita Caps Jeopardize the Health of Children and Other Vulnerable Populations, the bottom line is arbitrary cuts to Medicaid — whether through a per capita cap or block grant – would have a devastating impact on children’s coverage. Policy proposals that include per capita caps or block grants for Medicaid do nothing to control Medicaid costs. They just shift the burden from the federal government to the states, which would have to figure out how to make up the difference. States would face two choices – contribute more of their funds to keep the program whole or, more likely, institute deeps cuts to Medicaid enrollees and providers. Millions of children and families who rely on Medicaid for their health care would face increased costs, reduced benefits and many would become uninsured altogether.

The remarkable gains in coverage that has cut the numbers of uninsured children in half over the last two decades would surely be reversed if Medicaid per capita caps or block grants were enacted into law. One thing is sure, kids would be worse off. We must continue to fight to protect coverage for all of our vulnerable populations but we have a special obligation to keep making progress for our children.

On campaign trail, candidates health plans tout Medicaid cuts, ignoring impact on children @First_Focus #InvestInKids
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Want to learn more? First Focus is a bipartisan advocacy organization dedicated to making children and families the priority in federal policy and budget decisions. Read more about our work against Medicaid block grants and per capita caps.

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