Senate Republicans, in their recently unveiled bill to dismantle the Affordable Care Act, included cuts to Medicaid funding that are even more cynical than what the House version of the legislation imposed—on both a political and policy level.
To shore up the support of Senate conservatives, who might balk at how the Senate bill softened the phaseout of Medicaid expansion, Majority Leader Mitch McConnell (R-KY) made even more draconian cuts to the traditional Medicaid program in the long-term.
The way the Senate bill balances the interests of the GOP’s hard-right and more centrist factions is by allowing moderates to claim that they were able to at least cushion some of the Medicaid cuts in the near term, while hiding from the political impact of the long-term slashing.
“2025 is a long time off,” Sen. Bill Cassidy (R-LA) told reporters Thursday, referring to when the harsher form of the cuts would go into effect under the Senate GOP plan.
The changes Senate Republicans made to the House bill has to do with growth rate formulas for the traditional program. It’s a complicated aspect of how their plan works, but it’s essential in understanding why it would put the social safety net at risk.
Both the House and Senate GOP plans propose ending the current form of Medicaid as we know it. Currently, Medicaid operates as a state-federal partnership, where the federal government offers an unlimited match rate to state spending that varies state to state for an average of about 57 percent. Beginning in 2020, under the Republican proposals, the feds for the first time would put a cap on how much funding they’d offer states on a per enrollee basis (with the option for states to instead take a lump sum payment, known as a block grant).
The rate at which the caps rise over time is incredibly important in terms of how much federal spending this would represent. Because Medicaid spending increases at rates higher than other common measures of inflation, pegging the rise in the caps to a lower inflation level compounds as time goes on. The federal government would contribute an increasingly smaller portion of the total amount.
Under the House bill, the American Health Care Act, the inflation metric chosen was the consumer price index for medical care. (Older, blind and disabled enrollees would see their caps rise at a slightly more generous rate, because they’re the programs most expensive enrollees to cover.) Brookings predicted, by running the numbers on Medicaid spending as if the proposal had been implemented in 2004, it would result in an average 11 percent cut in funding by 2011, but vary widely by state. One state would see a 77 percent cut, and eight others at least 25 percent less in federal spending by the end of that period.
The Senate legislation follows that model until 2025, at which point it introduces an even slower, broader inflation metric, consumer price index for urban consumers.
The upshot of introducing this slower growth rate five years after the cap system is first introduced is that 2025 is at the end of the budget window that the Congressional Budget Office will be analyzing in its coming score of the bill. That means most of the additional coverage losses due to that change will not be included in their report.
But, as part of the so-called “reconciliation” process Senate Republicans are using to avoid a Democratic filibuster, how much money their bill saves in the “out years,” meaning the period after the first decade of its implementation, plays a role in determining if it saves the government enough money to be eligible for the reconciliation process.
In essence, that means Senate Republicans will be able reap all of the budgetary benefits of these late-in-the-game additional Medicaid cuts, without having to weather the ugly headlines of the increased coverage losses.
What gets me about these debates is how much better the GOP is with lies than the Dems are with the truth.
When Obamacare first passed the GOP claiming Obamacare was “evil” and lied by screaming about death panels and pulling the plug on Grandma. Now with a repeal that will take away healthcare from 23,000,000 Americans the GOP is claiming great success improving healthcare by freeing everyone from Obamacare.
The Dems on the other hand, have yet to make an emotional argument as to why the GOP plan is evil and, in truth, will result in tens of thousands of sick people and seniors being taken out of hospitals and nursing homes and dumped on street corners to die. I mean the result of the GOP’s plan is to gut Medicaid beyond the Obamacare expansion that 70% of nursing home patients rely for their care. What other option will nursing homes have but not to provide care for those who no longer have Medicaid? So yes, it is a fact that if the GOP plan passes many in nursing homes and other assisted care facilities will lose their care.
You have articulated my anger with the Democratic party. They seem to be incapable of standing up to genuine evil. It is way past time the American people were represented by politicians who care about them. We need a reformation of the Democratic party. It needs to be restored. It needs to actually care about working people and others who aren’t hedge fund managers.
Look especially hard at how Medicaid helps pay for seniors in nursing homes. Now digest this projection: the number of Alzheimer’s cases is predicted to triple by 2050. That’s simply based on demographics. Here is one of places you can read more about that.
http://www.deathandtaxesmag.com/335602/mitch-mcconnell-polio-government-assistance/
The conservatives have essentially unlimited and unreported money available with which to hire the most unscrupulous accountants and actuaries. Democrats have to go hat-in-hand to wealthy donors to get money for that kind of research report, and the conservatives use that to attack the very best and most effective Democratic politicians - the way they did Hillary when she gave speeches for money.
Ask the labor movement. The GOP is expert at going after the money sources that would make Democratic candidates competitive. But of course, YOU would never vote for or defend a Democratic candidate who gave speeches to Bankers, would you?