One health care "reform" idea being tossed around is Medicaid block grants. It appears Rep. Diane Black (R-TN) inquired to the CBO regarding how this might work. They responded, in part:

I understand from committee staff that there is interest in designing an option for a state to receive funding through a block grant with financial parameters comparable to the per-enrollee cap. The grant would be coupled with new flexibility, by which the federal government could cede more control to states for a range of program features. In CBO’s judgment, depending on the specifics of the proposal, such an option could be more attractive to some states than the AHCA’s per-enrollee cap, and its inclusion in the legislation would have budgetary effects relative to those under both current law and the AHCA.

The CBO also mentions that "The effects of various choices could interact in complicated ways."

Republican governors have advocated replacing Medicaid with a block grant program. Can you imagine the federal government giving the state of Tennessee billions of dollars for health care services with little or no oversight or regulation?

Also, can you imagine that Rep. Diane Black is chairman of the House Budget Committee?


CBO Letter to the Honorable Diane Black regarding establishing a Medicaid block grant

Kaiser Health News: Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans

Forbes: Opposition Mounts To Trump's Medicaid Block Grant Idea
(money quote: "The less you know about Medicaid, the more block grants make sense.")

bizgrrl's picture

“Moving from the current

“Moving from the current Medicaid financing structure to fixed federal Medicaid block grant funding would shift costs to states and state taxpayers.”

Can't see this working well in Tennessee. State taxpayers in TN will want the churches to handle any shortage.

R. Neal's picture

Well, look on the bright side

Well, look on the bright side at all the business opportunity.

"Coming soon to a Pilot Truck Stop near you: Junior Samples' Medicaid Scooter Outlet and Pain Clinic."

Mark Harmon's picture

Been there before...

I published this in the Tennessean, Jan. 4, 2014

Guy Williams had his blood pressure taken at CVS, got his flu shot at Kroger and had his cough treated at Walgreens. Still, he did a double take when he stood in front of the new location for his medical care. The sign read, “Pilot Travel Center.” An added sticker amended “and Health Clinic.”

Williams stepped around the gas pumps and entered. “Is that your pickup at pump 6?” asked the clerk.

“No,” responded Williams, “why do you ask?”

“Well, with that fill-up, the driver is entitled to a free lottery ticket or chest X-ray,” beamed the clerk.

“I didn’t drive here; I walked,” Williams said. “I’m here because I received a letter saying this is the only place
that will accept my Tennessee health insurance.”

“Oh, great,” said the clerk. “But next time, drive. We give a free blood test with any gas purchase.”

“I had to sell my car,” retorted Williams. “My boss cut our hours and eliminated benefits.”

“What a shame,” said the clerk. “By the way, my name is Rufus. What’s yours?”

“Guy Williams,” Guy replied — to no one in particular, because Rufus turned to handle a customer who bought cigarettes, lottery tickets, sweet tea and Funyuns.

“Sorry about the delay, Guy,” Rufus apologized. “The first thing I’m supposed to do is hand you this pamphlet on healthy habits and responsible money handling.”

“OK, I’ll read it,” Williams said, “but I’m not sure what this has to do with my rash, blistering sores or night sweats.”

“Hey, Guy,” chuckled Rufus, “who’s the clinical cashier here?”

“Clinical cashier?” pondered Williams. “Is that some sort of title or medical degree?”

“Heck, no,” stammered Rufus. “Tennessee’s health plan saves money by not having any of that bureaucratic stuff. So, Guy, would you please step up on that treadmill by the beer cooler and start walking?”

Guy did as requested as Rufus handled several gas customers. After about 10 minutes, he returned to check on Williams.

“Keep it up, Guy, you’re doing great,” encouraged the clerk.

“Is this some kind of stress test?” asked Williams.

“Oh, no, Guy, this generates power for the video playback. "There’s no such thing as a free ride in the Tennessee health plan.” Rufus then pulled out a video cart connected by a cord to the treadmill. “Here, you watch this while I put out more Krispy Kreme.”

An image of the governor flickered on the screen. He was in a kitchen. “Hi. This is Bill Haslam. Healthy living is good for whatever ails you — better meals and more exercise. So keep working that treadmill so you can power this lesson. Today, I’m going to show you a fantastic, low-calorie version of crème

“Cream what?” bellowed Williams, his face now florid and sweaty as the treadmill sped along.

“That’s enough for now, Guy,” yelled Rufus from behind the register. “I just checked and we have a requirement today for preventive care. But first I must collect your co-pay: $20.”

“There’s a co-pay?” blurted Williams.

“Of course. The Tennessee health plan doesn’t want anyone to take advantage of the system,” stated Rufus. “OK, I’ll need you to step behind the Bud Light display and drop your drawers. I’ll need a urine specimen in that discarded Slurpee cup for a drug test. We don’t want any drug abusers in our Tennessee health plan.”

Williams got off the treadmill and did as requested, but to Guy’s surprise there was another step. “Next is the prostate exam,” stated Rufus as he quickly put on a plastic glove, bent Frank over and conducted the exam in the usual manner.

“See, Guy,” said Rufus, “this is what the Tennessee health plan does for you.”

“I’m getting the point in a most dramatic way,” groaned Williams.

“Well, that’s it,” declared Rufus as he took off his glove, tossed it and grabbed Williams’ debit card all in one swift motion. He rang up the charge.

“I’m still not sure what this has to do with my rash,” murmured Williams.

“It’s just the Tennessee way,” noted Rufus. “Oh, I just noticed we had another discount. It should have been $15. We owe you 5 bucks. Hmmm, I could credit you a rebate.”

Guy looked up at the familiar Pilot logo and said, “Cash would be better.”

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