Whoever wins this presidential election will have a lot of big decisions to make within their first year in office. One of those decisions is what to do about states, like Texas, that haven’t expanded Medicaid to more low income people under the Affordable Care Act.
According to the websites for the campaigns of Democratic Presidential Candidate Hillary Clinton and Republican Candidate Donald Trump, both have widely different plans.
Medicaid under Trump
Trump wants to repeal the health care reform law and turn Medicaid into a block grant system.
The first part would be deeply complicated, but this block grant program is something conservatives have wanted for a long time.
Dr. Deane Waldman, a doctor turned health care policy director for the right-leaning Texas Public Policy Foundation, says, in theory, block grants are beneficial because they allow the federal government to hand states a pile of money and the state can prioritize how that pot of money is spent. But, he says, it doesn’t always work that way.
“Washington will say, ‘Yeah, we will give you money, but there are strings attached to it.'” he said. “And, they are pretty adamant about those strings and the strings are the control levers.”
Historically, a true block grant system has never been implemented in Medicaid, Waldman says. That’s why he thinks it’s highly unlikely it will happen in a Trump presidency.
“[A]s long as they control where that money goes, and how it gets apportioned, then the reality is that we haven’t gotten as a state, Texas, has not gotten the freedom that you think a block grant has given.”