A better way to rein in Medicaid

Medicaid is two things at once: a healthcare benefit for poor individuals, and a system of federal grants that disproportionately profits wealthy states.

Over the past four decades, Medicaid spending has grown more than any other category of public expenditure. Republicans have tried to rein in the cost of the program with “block grants” and “per capita caps.” But these would leave states short of funds in recessions, threatening state budgets and coverage for low-income beneficiaries when assistance is most needed.