Replace?

Gov. Romney gives a speech describing his approach to replacing the ACA. Quite a non serious speech from someone who knows quite a lot about health policy. Maybe he is pacing himself.

His clearest notion seems to be giving states flexibility via block granting of Medicaid to expand coverage.

Just keep in mind when you hear someone say block granting of Medicaid is a key part of a plan to expand coverage to uninsured folks that the big money in Medicaid now goes to the elderly, and disabled (mostly due to paying for Long Term Care).

If you block grant Medicaid and grow the block granted amount slower than health care inflation, it will be very hard (impossible) to provide similar services to the existing beneficiaries. With block granting, you either can’t expand coverage or you have to cut benefits and services, and most of the cuts will have to fall on the elderly and disabled. Most folks forget that Medicaid is at least 3 programs.

Block granting Medicaid is not a strategy to expand insurance coverage, unless it is combined with a plan to severely reduce long term care spending paid for by Medicaid for the elderly and disabled, or you are planning to spend more money via a block granted approach than is currently projected for Medicaid.

update: tweaked the post.