Sara Rosenbaum Discusses the Current Political Climate and the Effect on Medicaid

Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy and founding chair of the Department of Health Policy at the Milken Institute School of Public Health, George Washington University, discusses the potential impact the Trump administration will have on Medicaid programs.

What impact do you think the Trump administration’s willingness to provide waivers to states for their Medicaid programs could have on healthcare outcomes?
I think that the discussion that we are having now about how to make public health care financing better and stronger. This is a discussion that has been going on for as long as we’ve had public health insurance programs. We are now in the sixth decade of that. I don’t think that the administration initiative as they are framed now are being advanced to continue a long discussion about how to improve the performance of these programs. I think the administration made clear from the first day it took office that the Medicaid program originally was not intended to insure low-income people who were not connected to cash welfare. Nonetheless, it has evolved into that.

Now, it’s our public insurance program and the question is how to make it work better, how to create new options for using alternative approaches to public insurance that would look and feel maybe more like Medicare advance plans where Medicare buys from the private sector which we already do this in Medicaid. Expand the options, look for areas of efficiency in long term service and support. And I should note it’s about how we can support people who are poor and depend on Medicaid who need work supports and a job. But it’s not about creating circumstances where people are made to feel they are liable to lose something for no reason of their own. I don’t see that as the way to go. I also think that the discussion we need to have is around how to build support for work into Medicaid expansions not how to use the work demonstrations to roll back benefits.
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