If you think that this Congress or the Republican Party is done trying to repeal and replace the ACA then you are wrong. If you think they will study health care in America the way it deserves to be studied then you are also wrong. These folks want budget cuts and tax cuts and they want to find the money to get those things by cutting health care, especially by cutting Medicaid. Block grants are a way to make cuts to programs without having to publish them in a budget. So block grants will come up again and in arenas other than the health care arena.
We must keep insisting that Congress fix the ACA or give us some version of Single Payer. We don’t want no stinky block grants (chant to the tune of We don’t want no Education).
Why We Don’t Want No Stinky Block Grants
Block grants will not give us stable, reliable support for our health care costs. Block grants have been used more times in America than you might think. They were first proposed in 1949 by the Hoover Commission although the first block grant was not enacted until 1966. Nixon used Block Grants and Reagan wanted to see grants consolidated, and in the Omnibus Budget and Reconciliation Act of 1981 Congress obliged, turning 75 grants into 9 new or revised block grants. Overall funding was reduced by 12%.
“In 1996, the open-ended entitlement categorical grant, Aid to Families With Dependent Children was converted into the Temporary Assistance to Needy Families (TANF) block grant by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996”
Jocelyn Guyer from the Center for Children and Families published an article in 2012 which looks at how effectively that particular TANF block grant performed after the recession in 2008 and compares it to how the federally funded programs for food stamps and Medicaid functioned. She says,
“Poverty increased substantially during the recession from 12.5 percent in 2007 to 15.1 percent in 2010.TANF’s purpose is to help those falling into poverty, but according to research by the Center on Budget and Policy Priorities, it came up short in fulfilling its intended purpose. In 2010, over 7 million families with children were living in poverty but less than 2 million of them received welfare assistance. CBPP estimates that TANF serves only 27 families for every 100 families in poverty, down from 68 families for every 100 families in poverty before welfare reform.”
“SNAP and Medicaid faced the same economic pressures during the recession as TANF, however, they were far more successful in fulfilling their missions according to research by CCF and CBPP. As more people found themselves in poverty and the poor became poorer during the recession, SNAP responded effectively and kept any families out of poverty and lessened the severity of poverty for millions of others.
Medicaid also performed very well under pressure,” she says “with only two states reducing coverage and 29 states actually taking steps to improve coverage last year” (Remember, this is before the ACA) “As childhood poverty increased by 14% during the recession, the rate of uninsured children fell to record lows, with Medicaid (and CHIP) stepping in to fill the gap left by declining employer-sponsored insurance.”
“There was one other important factor in the success of Medicaid and SNAP in serving their intended purpose during the recession. Both Medicaid and SNAP are cost-effective programs with federal standards in place to ensure funds are used to help low-income families and individuals. On the other hand, the ‘flexibility’ of the block-granted TANF program has allowed states to divert as much as 44% of block grant funds from helping the poor to such unrelated purposes as road repairs or closing state budget holes.”
She ends with a question – “So you be the judge – does block granting important public programs work?”
Pros and Cons of Block Grants
Most of the reasons the Republicans favor block grants have to do with the fact that it is a “backdoor” way to cut the federal budget (it’s about money), and it meets their goals of giving responsibilities that they say should belong to the states, back to the states.
In an excellent paper entitled Block Grants: Perspectives and Controversies by Robert Jay Dilger and Eugene Boyd for the Congressional Research Service published on July 15, 2014 (see link above) you can find some in-depth information about block grants with lists of both pros and cons. The lists are too lengthy for this article and are not different, essentially, from those that are discussed here. I found this interesting –
“Representative Paul Ryan, chair of the House Committee on the Budget, has recommended that the federal share of Medicaid be converted into a block grant as a means to ‘improve the health care safety net for low-income Americans’ and to save $732 billion over 10 years.”
Perhaps this was new information in 2014 but we have heard far more about it than we ever wanted to.
“The House’s FY 2015 Concurrent Budget Resolution also would convert the Supplemental Assistance Program (food stamps) into a block grant, estimating the savings as $125 billion over ten years.
So here is an article from 2014 predicting what Republicans are trying to legislate in 2017. They have been trying to get to block grants for much longer than that. In fact, except for the block grants in 1966, most block grants have been passed in Republican administrations.
In a few limited projects, especially in terms of specific programs for community development, block grants have worked. However, this is about the health care of every American citizen and block grants just will not do. Nor will they do for any other safety net program. Past experience with block grants suggests:
- Block grant funds get cut as time goes on.
- Block grants do not work well long term.
- Block grants allow the federal government to keep strings attached to programs through oversight so the illusion of state independence is just that, an illusion.
- Funds from block grants often get syphoned off for emergency local needs and never replaced.
- Sometimes money is mismanaged when states and localities must spend down leftover funds at the end of the fiscal year to keep the amount of the block grant the same for the next year. When the new fiscal year begins people seem to get amnesia about where the funds originally came from.
If the funds for block grants will be sent to the Federal government and then will be given back to the states in block grants, why don’t the states just collect those tax dollars directly? Why send our dollars to the “feds” so they can send them back to the states and perhaps redistribute the tax dollars to states they favor as they threatened to do in the run up to trying to force a vote on the Graham-Cassidy Health Care bill, a bill that offered up the least helpful health care to come out of the 115th Congress so far.
If this is truly a “states’ rights” issue then perhaps the Federal government should play no role in it at all and should simply cut the portion of our taxes which helps contribute to national health care. Most likely Congress still wants to hold on to the purse strings for these block grants to use them in power plays, such as the recent attempt to extort votes on legislation, or so that they can dip their fingers in the pot when times get tight. Block grants are not real Federalism; they are Federalism in name only.
What Do We Want?
Here are the things the majority of the people want and the things we don’t want.
We don’t want block grants for health care, or Medicaid, or SNAP, or Medicare, or Social Security, or any program that affects the lives of large numbers of Americans.
We want the ACA restored to its original parameters. We need you to restore the individual mandates, the tax penalties and supports, the Medicaid expansion and the exchanges. We need you to reverse all the things you have done to sabotage this health plan. After all of the pieces you have removed from the ACA are back and functioning see if the plan still needs to be fixed and then fix it.
That’s what we want and this would not be difficult to implement.
Or, do as John McCain insists you should and use regular order to come up with a new bipartisan plan that does all the things the ACA does but does them more efficiently, and then let the plan get rated by the CBO. We would not be happy at all if the plan was another secret plan, hammered out in a back room without input from experts.
We must keep reminding our lawmakers that there are only two options that will cover the majority of Americans and that the majority of Americans are likely to support. Either restore the ACA to its original form, with all its facets back and functioning –
Or we will insist on a Single Payer plan and we won’t stop annoying you until we get it.
And one more point – the optics of forcibly arresting disabled protestors are terrible and just make us more determined than ever to oust the Republican Party, along with 45, from public office.
This is a view from the cheap seats.