Bob Goodlatte replies about Medicaid

Dear Mr. Gavaler:

Thank you for contacting me with your concerns regarding Medicaid. Medicaid is an important program for many Americans with limited income and resources but it is facing collapse if we don’t act to fix it now.

Optional state expansion of Medicaid under the Patient Protection and Affordable Care Act, commonly referred to as Obamacare, has significantly increased federal spending on the Medicaid program. In fact, the program now accounts for more than 15 percent of all federal health care spending and represents one in four dollars of a state’s average budget. This program currently supports over 72 million recipients, more than those currently enrolled in Medicare.

As you may know, Medicaid is both federally and state-funded, but states do not currently have enough control over the program. They are required to follow a “one-size-fits-all” program that is mandated by the federal government – a program that is not getting the job done.  Low reimbursements to health care providers and greater regulatory burdens have led to fewer and fewer physicians accepting Medicaid. Sadly, Medicaid patients are roughly twice as likely to visit the emergency department (ED) as those with private insurance. Medicaid beneficiaries shouldn’t be forced to visit an ED to get primary care.

It is clear reforms are needed to improve Medicaid; reforms that incentivize states to align their own Medicaid programs to their individual needs, as opposed to promoting unrestrained growth and spending.   You may be interested to know House Republicans have proposed various reforms to Medicaid under the “Better Way” agenda. The reforms proposed in this agenda aim to cap federal funding of the program and return control to those closest to the Medicaid beneficiaries – the states.

Under the “Better Way” plan, states would be given greater flexibility in how they receive their federal dollars, choosing between a per capita allotment or block grant, both of which are dependent on each state’s unique set of individual circumstances. The per capita allotment would be the default option, and would be based on a state’s average medical assistance and non-benefit expenditures in four beneficiary categories: aged, blind and disabled, children, and adults. If a state opted out of a per capita allotment, the second approach would grant a state a block grant of federal funds to finance their Medicaid program. Funding would be determined by a state’s Medicaid program for a base year, allowing the state to transition from federal expansion to managing their own eligibility and benefits for non-disabled, non-elderly adults and children. It is important that as we reform Medicaid, we ensure that states who have adopted a conservative approach to Medicaid, like Virginia, are not treated unfairly for their responsible fiscal decisions. You may read the entire proposal at

Rest assured, I will keep your views in mind as Congress considers all proposals to reform Medicaid in a way that protects current beneficiaries and ensures the long-term success of the program for the future.

I appreciate you taking the time to share your views with me. It is most important to keep an open line of communication so that I can best serve the interests of Virginia’s 6th District. I hope you will continue to be in touch with me as the 115th Congress debates issues of importance to the United States.

Again, thank you for the benefit of your comments. Please feel free to contact me whenever I may be of assistance.

With kind regards.


Bob Goodlatte
Member of Congress

Author: Chris Gavaler

Chris Gavaler is an associate professor at W&L University, comics editor of Shenandoah, and series editor of Bloomsbury Critical Guides in Comics Studies. He has published two novels: School for Tricksters (SMU 2011) and Pretend I’m Not Here (HarperCollins 2002); and six books of scholarship: On the Origin of Superheroes (Iowa 2015), Superhero Comics (Bloomsbury 2017), Superhero Thought Experiments (with Nathaniel Goldberg, Iowa 2019), Revising Fiction, Fact, and Faith (with Nathaniel Goldberg, Routledge 2020), Creating Comics (with Leigh Ann Beavers, Bloomsbury 2021), and The Comics Form (Bloomsbury forthcoming). His visual work appears in Ilanot Review, North American Review, Aquifer, and other journals.

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