By skyforbes 
I will admit right up front that I do not understand every detail of Medicaid enrollment/eligibility (my job mainly deals with what happens after you have coverage and are trying to use it), so my knowledge here will be a tiny bit incomplete.
However, there is at least one big proposed change to Medicaid that I want to make sure people understand, because it has catastrophic implications if it goes through.
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Currently, the ACA includes a Medicaid expansion provision. What this means, in practice, is that if you fill out an application for coverage on healthcare dot gov and your reported income is very low, the ACA will NOT provide you with a subsidy but will instead refer you to Medicaid to get coverage. (In many states, but not all. This was supposed to be the case in all states, but the Supreme Court changed it.)
Once you have Medicaid coverage, you have very minimal out of pocket costs (copays, etc) and there are no limits on how much healthcare you can use while you’re enrolled, as long as you’re getting a covered service under Medicaid. (So Medicaid will pay for twelve broken legs, but will not pay for an elective abortion because that’s not a covered Medicaid benefit.)
There are definite downsides to Medicaid — the coverages can be stingy, and it’s sometimes hard to find providers who will treat you. However, it’s coverage that definitely, absolutely helps people who are in a tough financial situation or health situation.
The GOP, naturally, does not like Medicaid. Their original plans all included a removal of the Medicaid expansion, until a bunch of Republican governors vocally opposed that plan.
So the new Ryan plan *does* include a provision that says that the Medicaid expansion established by the ACA will be kept in place until 2020.
After that, enrollment in the expansions would “freeze” and new enrollees would *not* be allowed to be added to the Medicaid expanasion plan.
(The assumption they’re making, apparently, is that people will be able to get off of Medicaid by 2020 and then it won’t be needed anymore. By anyone? Or else they just want to kill this program they don’t like regardless of its impact on people…but not until after the next presidential election. Of course.)
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Anyway, the really upsetting part of Ryan’s proposed plan that I want to draw your attention to is that they are suggesting that a “per capita cap” will be put into place for Medicaid, beginning in 2020.
What this jargon means is that the amount of money the government will pay toward a Medicaid enrollee’s bills will be capped.
This is not how it currently works. Currently, there are no limits on the amount of (covered) care a Medicaid recipient can use. (It’s worth noting that this is how private insurance plans work as well — thanks to the ACA. There are no longer lifetime maximums on healthcare plans, just like there were never any lifetime maximums on Medicaid plans.)
But Ryan and his colleagues want to change that. They want to cap the amount of care the federal government will give a state for each Medicaid recipient to a set amount per person (“per capita”). In other words, you get $500,000 (or whatever) of Medicaid money to spend in the rest of your life. Once you use that up, you’re done.
Maybe you’re thinking that’s not so bad, because you think poor people are lazy. Well, you should know that many Medicaid recipients are not who you think they are.
Sure, low-income adults are on Medicaid. Some of them long-term, many of them short-term. Many of them eventually move onto other coverage — employer or individual. People’s finances change and so do their insurance situations.
But more critically, many disabled or chronically ill people — especially children — are on Medicaid. Kids and adults with disabilities and chronic health conditions often have very high health costs and may not ever be able to work fulltime. Medicaid keeps those families from going bankrupt. Medicaid allows those children and disabled adults to continue to receive care and stay as healthy as possible. Medicaid keeps them afloat.
Also, many elderly people wind up on Medicaid near the end of their lives. Not many people know this, but Medicare does not include any coverage for long-term nursing care of any kind. *Many* people wind up on Medicaid once they need full-time care, since paying for inpatient nursing care out of pocket is not feasible for all but the ultrarich.
So here’s your take home point on this Medicaid thing:
Sick and disabled children, adults, and elderly people are able to live and die with some degree of dignity thanks to the fact that Medicaid does not have lifetime limits on coverage. Sick kids can have repeated surgeries, years of therapy, and years of medical care without plunging their families into bankruptcy. Elderly people can have a nursing home bed at the end of their lives without bankrupting their kids and grandkids.
No one kicks those sick kids or old people out of the children’s hospital or nursing home when they’ve hit some random dollar amount set by Congress.
Because of Medicaid.
Ryan and his friends, though, are hoping to change that.