President-elect Trump’s latest statement on Congressional Republicans’ campaign to repeal the Affordable Care Act shows just how little he understands a debate that has life and death stakes for millions of Americans.
For months, Trump has been all over the map: One day he’s pledging to provide “insurance for everybody,” the next he’s considering a so-called “replacement” plan that would pull the rug out from under some 21 million seniors, people with disabilities, children, and workers.
But on Wednesday, he took his cluelessness and unpredictability to a new low when he declared, “Whether it’s Medicaid block grants or whatever it may be, we have to make sure that people are taken care of.”
As fans of the 1980s cult classic The Princess Bride, there is only one appropriate response:
There are few surer ways to guarantee that people will NOT be “taken care of” than converting Medicaid into a block grant—a technical term that in reality means massive cuts.
Converting Medicaid into a block grant would end the program’s promise of health insurance for all eligible individuals. It would also slash the federal funding that states receive to run their Medicaid programs, forcing them either to make up the difference with money from their own coffers, or (much more likely) to make huge cuts in the coverage they provide to their residents. Faced with inadequate resources, states could have little choice but to institute waiting lists for coverage or cap enrollment—leaving millions of Americans without the care they need.
In fact, an Urban Institute analysis of a past GOP proposal to block grant Medicaid estimates that an additional 14 million to 20 million Americans would lose coverage under a Medicaid block grant—that’s on top of the 30 million who would lose coverage under ACA repeal and elimination of Medicaid expansion.
This isn’t a new idea. Congressional Republicans—including Representative Tom Price, Trump’s pick to lead the Department of Health and Human Services—have long had Medicaid block grants on their wish list. But what’s still unclear, as Trump swings recklessly from promising universal coverage to considering slashing health care for people who can’t afford insurance, is whether the President-elect is actually changing his opinion or if he is just so ignorant on health care policy that he doesn’t understand what he’s saying.
In either case, we can be sure of one thing: Trump’s willingness to embrace life-threatening policies without even making an effort to understand them is: