Remember the great Peanuts comic strip where every time Charlie Brown went to kick the football it was yanked away? Think of congressional Republicans as Charlie Brown and Medicaid as the football.
For 40 years, the GOP has tried to slash Medicaid, the federal-state health care program targeted at the poor. They’ll get some temporary wins, only to have that football yanked back. Over the past 40 years, Medicaid has grown more than Medicare.
They’re at it again.
As House Republicans try to initiate their politically impossible promise to balance the budget in ten years, Medicaid is their top target.
That’s because due to political pressure from Donald Trump, among others, they’re taking big ticket items like Social Security, Medicare and defense spending off the table. Although more than a few House Republicans would like to curb the big entitlements, they’re unwilling to incur the wrath of senior citizens, who tend to vote more Republican.
The chatter in the GOP is more about cutting taxes than it is raising revenues.
The Congressional Budget Office estimates if the big entitlements, defense, and taxes are off the table, it would require an 86 percent cut in the other discretionary domestic programs to achieve a balanced budget in a decade.
The juiciest target is Medicaid, which they consider a fast-growing poor person’s benefit. The more than $600 billion program — with states kicking in a similar amount — provides health care coverage to lower income Americans, people with disabilities and some seniors.
Efforts to enact big Medicaid cuts when the Gingrich Republicans took over the House in 1995 and then again in 2017 under Trump and a Republican Congress failed. Medicaid was a major reason Republicans were unable to kill Obamacare.
Russell Vought, who was Trump’s OMB director, has become the House Republican’s budget cutting guru. He has proposed massive spending reductions over the next decade, including some $2 trillion in Medicaid cuts and, among others, big decreases in Obamacare and the Supplemental Nutrition Assistance Program (SNAP), better known as food stamps.
The proposed cuts to Medicaid are predicated on the notion that most recipients are shiftless malcontents. That ignores the fact that 42 percent of all births in the United States are covered by Medicaid. Over 60 percent of nursing home residents are covered by Medicaid.
Medicare doesn’t cover any more than 100 days of care.
Vought projects half of the $2 trillion in Medicaid cuts would come from a work requirement. Presumably that wouldn’t be imposed on women about to give birth or seniors in nursing homes or those with disabilities. But a work requirement was attempted five years ago under a Republican administration and Congress. Most states rejected it as unworkable. One that tried was Arkansas. A study revealed that the main effect was to throw 18,000 Arkansans off Medicaid, with little additional employment.
A Congressional Budget Office report noted that while work requirements can be effective in some programs, in Medicaid there’s “little effect on employment.”
There is more than a little hypocrisy in these budget cutting schemes. Many of these right-wingers are self-styled populists — yet here they say, ‘the people be damned.’ Polls consistently show a high level of support for Medicaid. Under Obamacare, states have the option of expanded benefits. Every time that is put directly to voters in deeply conservative states like Idaho, Utah, Missouri, and Oklahoma, it carries.
As for dismantling the Affordable Health Care Act, Ezekiel Emanuel, one of the architects of the measure and a professor of medicine at the University of Pennsylvania, notes it’s “too woven into the system.”
Republicans also claim veterans’ benefits are untouchable in the drive for a balanced budget. But more than a million veterans’ families are on food stamps.
Vought and some of his congressional followers view the national debt as an existential threat. Then there were the Trump years, during which the national debt soared by almost $8 trillion; Vought was a top budget executive for three of those years. With a Democrat now in the White House, these guys are born-again deficit hawks.
At the same time House Republicans are taking Medicare off the table, they warn, correctly in this case, the Medicare hospital trust fund will be insolvent by 2028. President Biden acknowledged that and proposed a fix: hiking the Medicare payroll tax on investment income of wealthier Americans.
Some House Republicans talk about proposals ranging from lifting the eligibility age to partial privatization of Medicare. For now, that’s only fodder for think tank forums.
Republicans have to come up with a budget, however. Initially, it was supposed to be out in March; now they’re talking about April … or maybe May. Apparently, it takes time to conjure up sufficient blue smoke and mirrors.
Al Hunt is the former executive editor of Bloomberg News. He previously served as reporter, bureau chief and Washington editor for The Wall Street Journal. For almost a quarter century he wrote a column on politics for The Wall Street Journal, then The International New York Times and Bloomberg View. He hosts Politics War Room with James Carville. Follow him on Twitter @AlHuntDC.