The Republican's answer to Obamacare includes a proposal to set state caps on Medicaid financing, a plan that could shift costs to states, providers and beneficiaries, according to a Kaiser Family Foundation report released Wednesday.
The House GOP's "A Better Way" plan, released this week, includes a proposal to convert federal Medicaid financing from an open-ended entitlement to a per capita allotment or a block grant, based on state choice, according to the Kaiser report.
Under a Medicaid per capita cap, the federal government would set a limit on how much to reimburse states per enrollee. Payments to states would reflect changes in enrollment, the report said.
If costs are above per enrollee amounts, they could be shifted to states, providers and beneficiaries, the report said.
Kaiser said it's possible that the plan could give states an incentive to reduce Medicaid payment rates, restrict benefits and also the eligibility for high-cost enrollees. Costs could be shifted to beneficiaries through premiums or cost sharing.
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In turn, hospitals could end up bearing the cost of uncompensated care for beneficiaries who are unable to pick up a greater portion of the tab for healthcare.
The American Hospital Association could not be immediately reached for comment on the plan.
This fundamental change in the financing of Medicaid to pre-set growth rates is meant to contain federal healthcare spending, but does not account for changes in the costs per enrollee beyond the growth limit, nor for variation in the cost of medical services, patient acuity or epidemics, the report said.
To achieve federal savings, the per capita growth amounts would be set below the projected rates of growth under current law, Kaiser said.
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The proposal is part of a larger package designed to replace the Affordable Care Act, the report said. Often tied to deficit reduction, proposals to convert Medicaid's financing structure to a per capita cap or block grant have been proposed before, it said.
The per capita cap proposal is likely to be debated in Congress as part of broader healthcare policy and deficit reduction in an election year.
Twitter: @SusanJMorse