One of the best indications that politicians are trying to get away with something is when they feel compelled to lie about it. So it is with the current Republican effort to repeal the Affordable Care Act, and while much of the recent attention has been on the threat to the law’s protections for people with pre-existing conditions, there are even more sinister plans afoot.
I’m talking about the most significant and dramatic change the ACA brought about — the expansion of Medicaid — and Republican hopes of not just winding it back but making things dramatically worse than they were even before it was passed.
You may have missed this, what with the ongoing meltdown of democracy happening on Pennsylvania Avenue, but David Weigel and Elise Viebeck reported this:
Senate conservatives, once seen as an impediment to the Obamacare repeal push, are instead lobbying for changes that would drop millions of adults from Medicaid, limit the value of tax credits over concerns about funding abortion and weaken or cancel consumer protections.
To be clear, what they’re pushing for — and what Republicans have wanted for a long time — isn’t just revoking the ACA’s Medicaid expansion but going farther, to transform the program into block grants given to states and give them “flexibility,” which means allowing them to cut benefits and kick people off the program. This is apparently what hard-right conservatives like Ted Cruz and Mike Lee (both of whom are on the working group devising the Senate’s plan) are pushing for.
That’s not a universal position in the GOP. There are a few senators from states that accepted the Medicaid expansion — such as Rob Portman of Ohio; Shelley Moore Capito of West Virginia; and Cory Gardner of Colorado — that are nervous about tossing thousands or even hundreds of thousands of constituents off their health coverage.
But the majority view in the GOP is still that Medicaid has to be cut, rolled back, and block granted. Still, what’s most interesting is how those Republicans are talking about Medicaid — and the way that, for now at least, it seems like the public isn’t buying it.
In the bill passed by the House, a stunning $880 billion would be cut from Medicaid over 10 years. So how do you spin that? As Weigel reports today, Republicans are finding that it isn’t easy to do:
On Wednesday, Rep. Tom MacArthur (R-N.J.) spent nearly five hours answering questions from a disgruntled audience of constituents, some of whom spoke at length about what Medicaid meant in their communities. MacArthur was blown back by laughter when he argued, as House Speaker Paul D. Ryan (R-Wis.) has, that caps on per capita Medicaid funding would leave the system stronger.
How exactly is cutting the program supposed to make it stronger? When they get asked this question, Republicans reply with a lot of vague, positive-sounding words like “flexibility” and “patient-centered.” But they never say specifically how the program would change. Note what Secretary of Health and Human Services Tom Price said on Sunday when Jake Tapper asked him about that $880 billion cut:
“And we believe strongly that the Medicaid population that will be cared for in a better way under our program, because it will be more responsive to them. These decisions will be made closer to them.
“Right now, you have got Washington, D.C., dictating to the states and dictating to patients exactly what must occur. That’s not how a healthy health system works. A healthy health system works by allowing those individuals closest to the patients themselves to be making those decisions.”
If you believe Price, Medicaid is terribly unresponsive to patients, because Washington DC bureaucrats are…doing something or other. Medicaid patients are crying out for…again, something or other, and those nasty bureaucrats won’t respond. But he never tells you what.
Now here’s a fact that might surprise you: Medicaid patients are really happy with the program.
I know, I just blew your mind. But it’s true. In fact, they express more satisfaction than people on private insurance, and about as much satisfaction as elderly Americans on Medicare, which everyone considers politically untouchable because its recipients love it so much. Here’s a Morning Consult poll in which 87 percent of Medicaid patients express satisfaction with their coverage. Here’s a Gallup poll in which 75 percent say they’re satisfied, compared to 77 percent for Medicare and 69 percent for employer plans. Here’s a Commonwealth Fund survey in which 77 percent of those newly enrolled in Medicaid rated the coverage good, very good, or excellent.
How is such a thing possible? Why aren’t these people disgusted with the big-government, socialist beast they’ve been shackled to? Well, by definition, they’re people who are struggling economically. When you give them health coverage, it can be an incredible relief — even life changing. And Medicaid isn’t some complex bureaucratic nightmare. It’s insurance. Once you get it, your medical bills are paid. From the patient’s perspective, it’s pretty simple.
So why is it that Republicans are so determined to argue, against all evidence, that Medicaid is a disaster of a program that doesn’t work? The answer is that they have a moral objection to the program which they’re trying to pass off as a practical objection.
Every once in a while the mask slips and someone will make their moral position clear, as Sen. Orrin Hatch did the other day. When asked about public opposition to repealing the ACA, he said, “The public wants every dime they can be given. Let’s face it, once you get them on the dole, they’ll take every dime they can.” That’s a slightly more crude version of the mainstream Republican position, which is that Medicaid has grown out of control — it now insures about 70 million people — and it would be better if we could get all those moochers off the program and make them fend for themselves.
The belief underlying that position is that it is an inherently bad thing for a person to get health insurance from the government. Needless to say, liberals — and, it turns out, most Americans — don’t share that belief.
The practical argument, on the other hand, is at least in theory something people of all political stripes could agree on. If Medicaid really were in a shambles, wasting money and not serving its recipients well, then Democrats would want to change it, too. But it isn’t. It’s very big, and that presents challenges in how to fund it. But it’s doing its job, which is to provide health insurance to people who can’t otherwise afford it.
Republicans may be surprised by the fact that their proposal to slash the program is running into such opposition. There’s an old adage in Washington that “programs for the poor are poor programs,” meaning that because poor people don’t have political power, the programs targeted at them are always targets for cuts and elimination. Which is true in many ways. But one of the results of our current health care debate has been to make clear to people how many Americans depend on Medicaid. So all of a sudden, the disingenuous spin Republicans have offered for years on the subject isn’t passing the laugh test.