, 21 tweets, 7 min read Read on Twitter
REMINDER: Trump is nowhere close to done trying to dismantle Medicaid by fiat, after failing to get his cruel cuts through Congress.

A quick refresher on what “block-granting” Medicaid would mean and why it’s so dangerous.

1. “Block-grant” is code for converting a program from one that guarantees coverage to all who qualify, to one that helps fewer and fewer eligible people over time due to capped funding that declines year by year.

Here's what that would mean for Medicaid.
2. Medicaid is a federal-state program, meaning it’s partially funded by the federal government and partially by states. Currently the feds pick up a set percentage of states’ Medicaid costs.
3. A block grant would cap federal Medicaid funding, giving states a fixed $ amount and requiring them to pick up the rest.

Because block-granting is a backdoor strategy for making deep cuts, Medicaid block grants are intentionally designed to make cuts grow deeper every year.
4. By shifting costs to states in a huge way, block-granting Medicaid will force them to make dramatic cuts to their Medicaid programs. (Read: kick huge numbers of people off of health insurance.)
5. Analysis by the @urbaninstitute of the House GOP proposal to block-grant Medicaid during the recent health care fight estimated that **between 14 million and 21 million Americans** would lose Medicaid.
@urbaninstitute 6. One of the groups who’d be hurt the most: people with disabilities. This is because for many people with disabilities & severe health conditions, Medicaid provides a lot more than just health insurance—it enables independent living.
7. As the largest provider of home- and community-based services—think: personal attendant care, skilled nursing—Medicaid makes it possible for millions of people with disabilities to live independently & remain in their homes.
8. Loss of Medicaid would also push people with disabilities out of the workforce in droves—because the program’s home- and community-based services enable millions to work outside the home.
*more on the devastating effects of cutting Medicaid for people w/disabilities (via @rwest817 @kfgrobbins & me): americanprogress.org/issues/poverty…
@rwest817 @kfgrobbins 9. Worth noting: even people who aren’t kicked off Medicaid would be hurt, as we’d also see states cook up new ways to deny beneficiaries the medicines, procedures, tests & other critical services they need, in order to further reduce costs.
10. Dismantling Medicaid was a core part of Trump & Congressional Republicans’ recent healthcare repeal effort.

And the American people loudly & clearly said no--especially to Medicaid cuts.

@amprog polling found **80%** opposition to cutting Medicaid.
@amprog 11. Now Trump is (again) sidestepping Congress & trying to sabotage Medicaid by fiat after failing to get his agenda done legislatively—just like with his cruel Medicaid work reporting requirements, which have already cost more than 17,000 Arkansans their health insurance.
12. There are real questions about whether Trump has the legal authority to block-grant Medicaid by executive action. Lawsuits will inevitably follow if the administration moves forward with this plan.
13. Meanwhile, the newly Democratic-controlled House will try to block this cruel policy as well.

House Dems have already vowed to investigate the Trump administration’s health care sabotage efforts & several spoke out immediately against this latest move to slash Medicaid.
14. Make no mistake: people will die if Medicaid block grants take effect.

For context: the Congressional Budget Office estimated that more than 208,000 “unnecessary deaths” would occur by 2026 if the Senate GOP health care repeal plan had taken effect. vox.com/the-big-idea/2…
15. As a result, back during the 2017 health care fight, some took to calling Medicaid cuts like block grants “the real death panels.”
16. By contrast, *expanding* Medicaid in the states still refusing to do so would save over a hundred thousand lives over the coming decade, as my colleague @rwest817 has found.
17. We’ll see where things go from here in the coming days and weeks.

The Trump administration has said via its Medicare & Medicaid director @SeemaCMS Verma that it’s been carefully refining this cruel policy for weeks (recognizing how unpopular cutting Medicaid is).
18. Follow along for updates—and in the meantime, it wouldn't hurt to call your member of Congress to let them know what you think, especially now that the House will again be a check on Trump: 202-224-3121.

/end (for now)
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