First, they came for Social Security. But lots of people like Social Security, so they couldn’t privatize Social Security. Then, they came for Medicare. But lots of people like Medicare, so they couldn’t privatize Medicare. So now, they are coming for Medicaid. And Steve Benen and Ezra Klein are worried.
It’s hardly surprising that Paul Ryan and the GOP are going to try to hack Medicaid to bits: after all, it’s the only big thing left, if you leave Defense off the table, refuse to raise taxes on the wealthy, and beat hasty retreats with Social Security and Medicare. Will it work? Benen and Klein fear that it will, given that, as Klein argues
Medicaid goes to two groups of people: the poor and the disabled. Most of the program’s enrollees are kids from poor families, though most of the program’s money is spent on the small fraction of beneficiaries who are disabled and/or elderly. These groups have one thing in common, however: They’re politically powerless.
Perhaps this is over-optimism on my part, but I don’t think that the “disabled” and “elderly” are powerless. They both have well-organized lobbies. More to the point, however, is that Medicaid is the single largest payor in the country for nursing home care. More than two-thirds of Medicaid money goes to nursing home care, or at least that’s the number I have heard quoted. Put another way, there are literally tens of thousands of nursing homes around the country that rely upon Medicaid to pay their bills. Soon every Congressmember will know just how many nursing homes they have in their districts. Much of this care is scandalous, and you can just imagine what would happen if Medicaid was hacked apart across the country.
I’m not sure you could get worse visuals, either: we’re talking about elderly disabled people in wheelchairs. The House GOP won’t care a fig for the human costs, but they will care about political costs, and I believe that those will be huge. Can you imagine the thousands of families who will testify about how Medicaid has saved their families’ budgets?
Ezra also notes, accurately, that
Medicaid is a state-federal match, and it absolutely kills states during recessions, as unlike the federal government, states can’t run deficits, and so they find themselves with increased Medicaid costs because they have more people in need but decreased revenues.
True again. But if the elderly disabled are thrown out on the street, guess who is going to have to pick up a lot of those costs? States and localities. There will be enormous political pressure on lower levels of government to somehow deal with the problem. That’s the reason why, as much as the states don’t like Medicaid mandates, every single one of them has elected to have the program (remember, a state doesn’t have to have Medicaid).
So Steve and Ezra are right to be worried about the GOP’s plans. But we should not undersell progressives’ bargaining leverage here. Medicaid has a lot of important and sympathetic constituencies behind it.
Somehow Republicans have become convinced that their deeply unpopular policies are actually popular, and Democrats have become convinced that their deeply popular policies are actually unpopular. I’m not exactly sure how that has happened; maybe it’s Beltway Fever. But it’s time to stop internalizing it. This is a fight we can win, and make the GOP look very bad in the process.