No Dice to Medicaid Cuts

I have long felt that it was unlikely that the President would allow substantial cuts to health care programs, since it is his signature issue. But since everyone in DC has come down with Deficit Fever, I’ve become a little bit worried that he might be coerced into cutting Medicaid since it’s seen by many people as a "welfare" program and who likes that? (This was why I was always more worried about Social Security — it’s not a health care program and so less likely to be protected by the president in a Grand Bargain.)

If Gene Sperling’s words are any indication, the White House is not going to use health care as a bargaining chip:

He said Mr. Ryan has “put himself in a box” with his unwillingness to raise tax revenue. He said this forced Republicans to call for “very severe cuts” that if “explored” by Americans “they would not be proud of.”

Mr. Sperling attacked the House Republican proposals to overhaul Medicare and Medicaid, saying that the $770 billion in savings Republicans wanted from changing Medicaid would be unneccessary if Republicans would agree to roll back certain tax cuts.

“You can’t say to anybody who would be affected by that, that we have to do that, that we have no choice,” he said. “The fact is that all of those savings would be unnecessary if you were not funding the high income tax cuts.”

He also said that Mr. Ryan was wrong when he said that raising taxes as part of a broader package would hurt economic growth.

“Everything he said I heard nine million times in 1993,” said Mr. Sperling, who was NEC deputy director in the Clinton administration and later became Mr. Clinton’s national economic adviser.

This is really important. Sperling has ben one of the foremost proponents of the Grand Bargain and this pretty unequivocally takes Medicaid cuts off the table.

It will always be vulnerable — whenever the Republicans get the chance they will try to cut Medicaid, especially once it is expanded to cover more people. They will be desperate to call it a welfare program that somehow is keeping people from being productive members of society. But if the Dems can at least protect what exists now and get the expansion enacted it will be harder. Sperling’s comments were terribly important in that it positioned it as a safety net program that helps the middle class as much as the poor and I’m not sure most people know that.

Update: Dday has the full transcript of Sperling’s remarks:

And I say this to everybody in this room, there is enormous discussion about the revenue side and the Medicare side. But from a policy perspective, from a values perspective, we should be very deeply troubled by the Medicaid cuts in the House Republican plan. I want to make clear what they are. This is not my numbers, this is theirs.

After they completely repeal the Affordable Care act, which would take away coverage for 34 million Americans, according to the Congressional Budget Office. After they’ve completely repealed that, they do a block grant that would cut Medicaid by $770 billion. In 2021, that would cut the program by 35 percent. Under their own numbers, by 2030, it would cut projected spending in Medicaid by half. By 49 percent. So, of course– I don’t think– or imply any negative intentions or– lack of compassion. But there is a tyranny of the numbers that we have to face.

And here’s the tyranny of the numbers. Sixty-four percent of Medicaid spending goes to older people in nursing homes or families who have someone with serious disabilities. Another 22 percent goes to 35 million very poor children. Now I ask you, how could you possibly cut 35 percent of that budget and not hurt hundreds of thousands, if not millions of families who are dealing with a parent or a grandparent in a nursing home, or a child with serious disabilities. How is the math possible.

If you tried to protect them mathematically, you would have to eliminate coverage for all 34 million children. Now I know some people didn’t like when– the President mentioned that this was going to be very negative for families, for those amazingly brave parents. And he may be one of them in our country, who have a child with autism or Down’s and who just are enormously committed and dedicated to doing everything they can to give their child the same chance– every other child has.

But here’s the reality. Medicaid does help so many families in those situations. Over the years, we’ve allowed more middle class families who have a child with autism to get help in Medicaid. There’s a medical needy program that says when you spend down– we’ll– we’ll count the income after you’ve spent down medical costs.

There’s a Katie Beckett (PH) program that was passed by President Reagan that says if you have a child that’s in need of institutional care– you can get help from Medicaid. This is– this is a life support for many of these families. But these are the optional programs in Medicaid. These are the ones that go to more middle class families. If you’re going to cut 49 percent of projected Medicaid spending by 2030, do you really think these programs will not be seriously hurt.

So when we say that there– that the tyranny of the math is that these– these– this Medicaid– program, this Medicaid cut will lead to millions of poor children, children with serious disabilities, children with autism– elderly Americans in nursing homes losing their coverage or being– or– or having it significantly cut, we are not criticizing their plan. We are just simply explaining their plan.

Can any American know that that none of these things will ever happen to them?

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