by Max Brantley
The Senate Obamacare overhaul bill cuts a massive amount of federal funding of health coverage — a cut that will only increase in time – and replaces it with a comparatively minuscule pot of health care funding for the states. How that money will be used to paper over the massive spending cut will be left largely to the discretion of the Department of Health and Human Services, meaning the states will have to compete for the pool of available funds with no guarantees they’ll get the assistance they’ll need to make up for the shortfall.First, reduced spending is reduced spending. Second, in terms of health policy, Arkansas has functioned as a "blue" state with its generous use of Medicaid expansion money. When there's less money for all and we've been disproportionately spending more than many, it doesn't take a slide rule to figure Arkansas is in great peril, even as a Trump state with a Republican governor.
“The [HHS] Secretary can do what he wants or she wants with the money,” Timothy Jost, a health law specialist at Washington and Lee University, told TPM.
The ambiguous language gives the HHS significant power as President Trump seeks to push wary GOP senators into supporting the widely criticized bill. It sets up a scenario in which the administration can dole out funding as its discretion, giving it leverage over states struggling to make ends meet, while on the flip side giving the Republican administration the opportunity to stiff blue states.