Medicaid covers 70 million people while Obamacare covers 20 million. Medicaid expansion was the lions share of enrollment under Obamacare and Medicaid is now over three times bigger than the non-Medicaid part of Obamacare.
If the House passes the Trump-Ryan bill today the country will be a major step closer to endangering quality of medical care for more than one in five Americans enrolled now in Medicaid. States like Kentucky with a mushrooming opioid epidemic will be hamstrung in changing care to meet such a new epidemic by per capita funding of benefits. New life saving procedures will be unavailable to millions because of this cap on benefits. At best with the rapid pace of medical progress within a decade Medicaid will become more and more useless to those it would cover adequately without this change.
As for state control... that depends on the state
Barbour’s outspoken advocacy of state control over Medicaid has brought attention to his own record. Both supporters and detractors find much to draw upon: Critics say he has slowed spending growth in the state’s nearly $5 billion a year program at the expense of the neediest and most vulnerable residents. Given free rein, he would cut even further, they fear.
“It would wither on the vine like grapes in a hot sun,” says state Rep. Dirk Dedeaux, a Democrat and chairman of the House Medicaid Committee.
Given total control states like Mississippi might well place the per capita limit on individuals, turning hospital billing departments into death panels. The tender mercies of sociopaths like Governor Barbarous should not determine any Americans health care.