No block grants for Medicaid

Candidate Donald Trump promised to shift Medicaid into a block grant program as a way to give states more control and curtail spending. Two years into office, no Medicaid block grant proposal has successfully made its way through Congress.

Today, the government's insurance program for the poor is an entitlement. Anyone who qualifies is covered for services defined by Washington and the states. Broadly, the federal government pays half or more of the cost and the states shoulder the rest.

A block grant would dole out money to each state based on a formula, and the formulas so far have led to lower federal outlays. Supporters say states would be more efficient. Critics say there would be less care.

The most recent major effort in Congress tackled only expanded Medicaid, the part of the Affordable Care Act that allowed states to open the program to any low-income adult. The 2017 Graham-Cassidy bill would have created a large block grant to replace money for expanded Medicaid and the private insurance subsidies under the Affordable Care Act.

That bill never came to a vote when it became clear it lacked enough support to pass.

In its FY 2019 budget proposal, Trump's Health and Human Services Department said it "supports the comprehensive Medicaid reform in the Graham-Cassidy-Heller-Johnson bill, including modernization of Medicaid financing and repeal of the Obamacare's Medicaid expansion."

But there was no legislative action on that front in 2018.

And with Democrats controlling the House, it is difficult to imagine a deal under which they would accept converting Medicaid to a block grant.

This is a Promise Broken. That can change based on what happens during the remainder of Trump's first term.