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Credit: Gage Skidmore - https://commons.wikimedia.org/wiki/File:Donald_Trump_by_Gage_Skidmore_3_(cropped).jpg This article examines the Trumpcare impact on Medicaid. It is expected that Trump's changes to Medicaid will be a drastic departure from the last 8 years.

Medicaid is the subject of the sixth point of Trumpcare:

Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.

Trump's plan to repeal Obamacare will cost 21 million people their insurance coverage. Trump has declined to provide hard financial data regarding his plan, but his plan does include existing aspects of Obamacare like making health insurance premiums tax-deductible and it includes provisions for establishing tax-free savings accounts specifically for medical expenses. These concessions would cover 5% of the 21 million Americans who would otherwise lose coverage under his plan.[1]

One of Trump's major cost-cutting measures, and one that has been a favorite of conservatives since Reagan, is to "block-grant" Medicaid[2] for the states. Block-granting would have the federal government provide a specific budget amount to the states as a lump sum to use for the state-run Medicaid programs without the federal oversight and regulation. Critics of block-granting Medicaid claim that the funding would be outpaced by the growth of Medicaid costs. The Center on Budget and Policy Priorities have indicated that this type of program would lead to a growth reduction of 1.5 to 2 percent annually.[3]

Conservative response has been insubstantial, essentially rallying around the idea that it would decrease fraud and discourage states from attempting to lump as many services under the purview of Medicaid as possible. Proposals in the past, put forward by Newt Gingrich, George W. Bush and Paul Ryan, have indicated billions of potential savings. Without any specifics regarding the size or scope of block grants, it is difficult to correlate Trump's plan with relevant past calculations. While conservatives argue that block grants, if properly implemented, could feasibly replace Obamacare, there is no indication that health coverage would not decrease. As with many of his stated policies, Trump includes enforcement of existing immigration laws as an additional source of Medicaid cost reduction.