Through an executive action called “Healthy Adult Opportunity,” the Trump Administration is poised to overhaul the fundamentals of Medicaid, a state-federal health insurance program for low-income people, putting the elderly, children, and other poor people at risk of losing coverage or benefits.
Colorado’s congressional Republicans are largely keeping quiet on where they stand, while most Democrats oppose the change.
The Trump program, which some say over-steps presidential authority and undermines the intent of the Medicaid law, would allow states to apply for a waiver that would cap the amount of money the federal government is required to contribute to Medicaid–effectively turning it into a block-grant program.
In return, states would gain more flexibility over whom they’re required to cover with Medicaid and greater authority to kick people off the program or raise fees or co-payments for health services for Medicaid recipients.
Congress rejected block grants when it defeated the Republican push to overturn Obamacare in 2017.
Now, the Trump administration is trying to bypass the legislative branch entirely, and Colorado lawmakers are split on where they stand.
A spokesperson for Democratic Rep. Ed Perlmutter (D-CO) said he opposed the change, and along with other Colorado Democrats voted for a resolution expressing disapproval.
Democrat Joe Neguse (R-CO) said through a spokesperson that he “vehemently” opposed what he called a “direct assault on a critical lifeline that thousands of families across Colorado rely on.”
“While the President continues his all-out attack on American’s health care and proposes draconian cuts to Medicaid, Medicare and Social Security, in the House we are working to lower health care costs and prescription drug costs, protect individuals with pre-existing conditions and strengthen the pillars of health and financial security for every American,” said Neguse’s office.
Colorado Republicans have been more tight-lipped.
U.S. Rep Doug Lamborn’s (R-CO) office said he had no official position on the policy, although in February he said that he was excited after Trump State of the Union address to tackle federal spending, saying “for whatever reasons, we haven’t really talked about the entitlement part of our budget, which is 60% or higher.”
The offices of Representative Scott Tipton (R-CO) and Sen. Cory Gardner (R-CO) did not respond to requests for comment.
Lamborn, Tipton and Rep. Ken Buck (R-CO) voted against a House resolution condemning the Medicaid proposal.
Right now, states and the federal government are locked into spending certain proportion of medical costs that can fluctuate year to year. Converting this system to a block grant has been a long-time conservative goal.
Adam Fox, director of strategic engagement for the Colorado Consumer Health Initiative, called the Healthy Adult Opportunity a “backdoor attempt to undermine the Medicaid program.”
The proposal, he said, would lead to inequality in coverage between states depending on which chose to apply for waivers, could lead to Medicaid being “chronically underfunded” in the long run, and would be “very harmful to the health of [the Colorado delegation’s constituents].”
In the short-term, under its current leadership, Colorado would be unlikely to accept Trump’s offer to change Medicaid, but future administrations may choose to do so.
If the state were to move to a block grant form of Medicaid, he said, it could result in a situation where “we might have to cut service for older citizens, people with disabilities and children.”
The state’s budget is already tight, and with limitations on raising funds like the Taxpayer Bill of Rights, in an economic downturn the state could not count on any federal money over the cap, and might have to cut services.
Moreover, making changes to Medicaid through executive order is “overriding the will of Congress,” said Fox.
Still given Republican control of the Senate, Fox said any chance of stopping the change will likely come through the courts rather than the legislature.
A previous Trump change to Medicaid, allowing states to require recipients to work, is stalled in the courts.