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Hullabaloo


Sunday, April 03, 2011

 
Attack on the Medicaid Expansion

by digby


I'm in a bad mood today, so I'm probably going to keep saying "I told you so" as I read article after article about Paul Ryan's assault on the so-called entitlements. The shock and dismay at his attack on the Medicaid expansion in the Health Care bill among HCA cheerleaders is especially galling considering all the pooh poohing those of us who predicted it had to endure during the legislative battle. I was told repeatedly that it simply couldn't happen, there was no reason to be so cynical and that once it was passed there was no way it could ever be repealed. And since the Medicaid expansion was the main piece of the HCA that liberals couldn't walk away from in good conscience, it was used as blackmail to keep them from defecting when the rest of the bill became a rickety, market oriented construct that would only cover a fraction of the uninsured without it.

So here we are:

House Republicans are planning to cut roughly $1 trillion over 10 years from Medicaid, the government health insurance program for the poor and disabled, as part of their fiscal 2012 budget, which they will unveil early next month, according to several GOP sources...

The entitlement cuts represent a major battleground for the parties from now through the 2012 election: Democrats are already accusing Republicans of slashing benefits for the neediest Americans, but Republicans say Medicaid needs to be reformed to give states more flexibility in how they use federal dollars — and to rein in costs for both the federal government and state legislatures, which are swimming in red ink because of health care expenditures.

To bolster their cause, GOP leaders point to years of requests from governors to reform Medicaid so their states aren’t on the hook for so much money in the federal-state partnership.

Because the new health care law includes a major expansion of the program, there’s a double bonus for GOP leaders slashing it: It’s a bigger pot than it used to be, and it’s a major component of what Republicans derisively call “Obamacare.”


I am actually quite skeptical that Obama will allow this one to happen unless the Republicans come up with a mechanism that is so obscure that they can't brag about sticking it to the poor, which would defeat their purpose. I believe that Obama will be protective of his legacy on Health Care and will not let them do anything obviously draconian to it. Indeed, that's why I've been more frantic about Social Security. It's the one place they can all agree to cut and use as an example of their fiscal rectitude without having any immediate repercussions for actual people (and which Obama can use to offset the "socialist" label.) There's a huge political risk, of course. But if they jump off the cliff together the Democrats foolishly believe it will be lessened considerably for them.

The question, of course, is why would the Republicans want to give Obama any cover? I don't think they do, so this cat and mouse game around Social Security continues. The danger comes from the Democrats doing it themselves with only minimal GOP support. Keep in mind, the fact that they are allegedly coming after Medicare after the campaign they just ran in 2010 is a testament to the truism that consistency among their tribe is irrelevant. They are masters of epistemological relativism (also known as "I know you are but what am I" politics.)

Ryan coming out with his screw-the-old-and-sick blueprint from the far right could tempt the White House into making the first move on SS out of a reflexive protection of the health care plan. It could also divert a whole lot of liberal resources to fighting yet another battle they shouldn't have to fight --- this one can be taken care of immediately with a strong, unambiguous veto threat from the president. If we don't get one, I would take it as a possible signal that the White House is happy to have everyone running in several different directions.

But none of this means the Republicans aren't going to keep trying to defund Medicaid as long as it takes to get the job done. And keep in mind they are perfectly happy to whittle away at it, year over year until it has become nothing more than a bleached out carcass of what it used to be. They are very good at playing the long game and it's useful to them to have "welfare" programs out there to attack. It's what keeps the haters revved up.

Update: I guess I should at least entertain the idea that Obama is open to repealing or substantially privatizing the Medicaid portion of the HCA. It's hard for me to believe that he'd jeopardize his own legacy by hugely reducing the number of people covered, but there are ways to pretend that isn't happening. And the changes won't take place until 2014. It's possible, but I still think it's doubtful. He paid a big price for that legislation and it is the one thing I think he will protect.

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