One of the most amusing features of the Bush presidency has been W.'s frequent pretence that he has no influence at all over his party in Congress. Here's a guy who's been relentlessly marketed as a World-Historical Figure, a veritable Collossus astride the currents of world affairs, who has terrified al Qaeda into inaction and is now busily extending freedom and democracy to the benighted corners of the globe. Yet when it suits his purposes, Bush acts like a ninny-faced weakling in terms of his clout with GOPers on the Hill.
Usually he peforms this act when he wants to endorse a popular initiative without running the risk that it will actually be written into law, such as the extension of the Assault Weapons Ban or the tougher provisions of Intelligence Reform. According to Connolly and Balz in today's Washington Post, however, he's using a variation of this pose in negotiations with the nation's governors over the future of Medicaid: do it my way, or those Bad Elephants in Congress will do Bad Things to you.
The Budget Budget, as you may recall, proposed $60 billion in Medicaid "savings" through action on ill-defined "loopholes" in the program. In the run-up to Bush's personal meeting with the governors, his HHS Secretary, Mike Leavitt, suggested that the states should cut a deal with the administration lest Congress find some really hurtful ways to come up with the "savings." This is probably a thinly veiled reference to that hardy perennial of GOP budgeting, a Medicaid "cap" that would just arbitrarily limit federal spending on the program and let states cut services or eligibility to make ends meet. Indeed, the administration itself embraced the "cap" blame-shift as recently as last year.
Reading beetween the lines, the "deal" Bush and Leavitt seem to want is an agreement to crack down on states that are allegedly gaming the program for extra dollars, and to crack down on middle-class families who are allegedly gaming the program by shifting assets around to qualify for long-term nursing home care under Medicaid. To be sure, the administration will offer states plenty of new "flexibility" in exchange for helping Bush deal with his deliberately engineered budget crisis, but it will be flexibility to cut benefits, not to improve health services. Indeed, the other weapon the administration has in its quiver is to go hog wild with Medicaid waivers to let Republican governors like Haley Barbour and Jeb Bush do their worst.
Fortunately, there doesn't seem to be any big impetus among the govs--especically Democratic govs--to cut a deal. And the best comment on the whole Bush gambit was by Arizona Gov. Janet Napolitano: "What I'm worried about is this is all about the budget and not about health care reform."
Since we are talking about the country's main health care safety net program, which is the last line of support keeping millions of low-income families from joining the already-obscene levels of the uninsured, that's the heart of the matter.