Amongst all the terrible, horrible, no good, very bad 142-pages of the so-called “Better Care Reconciliation Act” (BCRA), I will forgive you if you somehow missed the provision about bridges. Take a look at Section 134, the section that allows states to operate part of their Medicaid programs through a block grant. It is bad enough that BCRA takes well over $800 billion from Medicaid by requiring states to implement per capita caps and essentially eliminates Medicaid Expansion. But Senate measure also allows states to convert Medicaid into a block grant, further limiting the funds available to pay for health care for low-income children, people with disabilities, seniors, adults, and pregnant women.But what is this about Medicaid buying bridges? The Senate bill would allow states to rollover funds from their block grant that they do not spend in a given year. Does it have to spend those rollover funds on health care? This is supposed to be the “better care” bill, so you might assume the answer would be, “yes.” But you would be wrong. Dead wrong!
Medicaid currently prohibits states from using Medicaid funds to pay for roads, bridges, stadiums or any item or service not covered by Medicaid. Seems straightforward enough, right? Spend dollars allocated to health care on actual health care. But the Senate bill exempts states from this requirement. Sure BCRA has some language that the rollover funds still have to be spent for any purpose consistent with “quality standards” established by HHS under the block grant requirements. But what would prevent the HHS secretary from deciding that Medicaid can now be a slush fund for President Trump’s infrastructure projects? If the Senate does not want states to use rollover funds to pay for roads, bridges, and stadiums, why include an explicit exemption to this provision?
Sorry but I think the only conclusion is that this provision further illustrates the goals of BCRA – not to provide “better care” to those who really need it but to transfer vast amounts of wealth to the richest individuals and corporations among us — not to mention helping to achieve the president’s promises to build infrastructure.
Did the Senate really expect that we would not find this provision? Instead of the “Better Care” act, I’m going to start calling it the “Bridges for Cars Reconstruction Act.” But there’s one more critical question – when Medicaid funds are used to build the next NFL stadium, will Medicaid also get the naming rights?
