IT’S BECOME a consensus position among the Republican presidential candidates that Medicaid, a federal entitlement program best known for providing health care to the poor, should be turned over to the states as a block-grant program. States know their own needs, the logic goes, and will use fixed grants creatively and efficiency — as opposed to a federal bureaucracy that writes checks on behalf of all who qualify. But if only it were that simple.
In a debate earlier this month, Mitt Romney, Rick Perry, Newt Gingrich, and Rick Santorum all backed the idea of cutting Medicaid costs by letting states administer the program. Many of those savings, though, would come on the backs of those who depend on Medicaid, the health care providers who serve them, or state taxpayers.