It’s light on details, but so far the Trump administration has proposed one big change to how we pay for health care in the U.S. President Donald Trump wants to turn the federal Medicaid program into a block grant system. This basically means states would get a fixed amount of money from the feds to run the program themselves.
This idea has been popular among conservatives in Texas, but there are a lot of reasons it has never happened.
You don’t have to go too far back to find a Texas Republican espousing the virtues of a block grant program.
Back in 1995, then-Texas Gov. George W. Bush visited congressional leaders during the government shutdown and tried to convince them to turn the keys to the Medicaid program over to him and other governors
“Texans can run Texas. We are willing to help balance the budget, but we want the freedom to run our Medicaid program,” he told reporters on Capitol Hill.
Congress didn’t capitulate, though. In fact, even when Bush became president he couldn’t make a block grant system happen.
Dr. Deane Waldman with the Texas Public Policy Foundation, a conservative think tank here in Austin, says it’s too bad because this was how Medicaid was always supposed to be. He says the 1965 wording of the law states that Medicaid programs will be “jointly funded, state administered.”
But Anne Dunkelberg with the left-leaning Center for Public Policy Priorities points out that the program has changed a lot since the 1960s.