House Democrats are vowing a fierce fight over Medicaid as Republicans eye plans to curb spending for the low-income health care program in the name of deficit reduction.
Joining President Biden, the Democrats are warning that Medicaid cuts would disproportionately impact the same vulnerable populations least able to absorb the hit, including low-income kids, seniors and the disabled, who together represent almost three-quarters of Medicaid spending.
Heading into the year’s coming budget battles, Democrats are pledging to defend the program from the GOP’s cost-cutting designs, raising the stakes in the prickly debate over how to hike the debt ceiling and heightening the chances of a government shutdown later in the year.
“We’re going to resist them completely,” said Rep. Frank Pallone, Jr. (N.J.), senior Democrat on the Energy and Commerce Committee, which has jurisdiction over the Medicaid program.
The federal entitlements have long been a target of a Republican Party whose traditional brand has featured ideological opposition to government-run health and retirement programs. This year, however, GOP leaders have repeatedly vowed to protect Social Security and Medicare – a reversal heavily influenced by the 2016 arrival of Donald Trump, whose support for both programs helped fuel his populist campaign and propel him into the White House that year.
Speaker Kevin McCarthy (R-Calif.) has said both programs are “off the table” in the debt ceiling debate, and even deficit hawks in the far-right Freedom Caucus have endorsed that sentiment.
Yet Republican leaders are also pledging to craft a federal budget that balances revenues and expenditures within a decade – a promise McCarthy made to the conservative critics in his conference as a way of winning their support in his hard-fought bid for the Speakership in January.
With major budget items off the table – including tax hikes and cuts to the Pentagon, Social Security and Medicare – many Republicans view Medicaid, as well as ObamaCare, as a key target in their deficit-reducing designs.
A number of conservatives – including Reps. Matt Gaetz (R-Fla.), Chip Roy (R-Texas) and Brett Guthrie (R-Ky.) – are lining up behind proposals to overhaul Medicaid, including plans to cap spending and apply strict new work requirements governing eligibility. And some of those ideas are receiving a welcome reception from other well-placed Republicans, including Rep. Cathy McMorris Rodgers (Wash.), who chairs the Energy and Commerce Committee.
McMorris Rodgers characterized Medicaid as “a very important safety net” – one Republicans want to protect – but pointed to several areas where Republicans see opportunities to cut costs. She’s questioning the wisdom of two Obama-era changes in particular: The expansion of Medicaid to cover almost everyone up to a certain income level, including able-bodied adults; and the enhanced matching rate, also adopted under ObamaCare, that bills most Medicaid costs for the expansion population to the federal government versus the states.
“Historically, Medicaid has been a partnership between the federal government and the state government, and for traditional Medicaid, it’s still 50-50. But for the expansion populations, it’s like a 90-10. And we need to look at that,” McMorris Rodgers said. “We need to make sure that we keep the strong safety net. But [we have] a lot of questions about: Is the match where it should be?”
McMorris Rodgers also expressed support for new work requirements as a condition of eligibility for certain beneficiaries.
“A lot of Republicans believe that more flexibility within Medicaid would lead to opportunities for better outcomes at a lower cost,” she said.
Some House Republicans are taking cues from Russ Vought, Trump’s former budget director, who has distributed a lengthy set of cost-cutting proposals to guide the GOP through the looming budget debates. Among his recommendations are provisions to slash roughly $2 trillion from Medicaid, and more than $600 billion from ObamaCare, over the next decade.
Those positions put Republicans on a collision course with Democrats, who consider those changes to be benefit cuts that they’d never support.
“As long as I’ve been here, Republicans have always wanted to cut Medicaid,” said Pallone. “And we can’t allow that, because the people on Medicaid are the lowest income. They have no alternative, so obviously we’re going to oppose any of those cuts.”
“If they’re talking about these kinds of cuts I think Medicaid is definitely at risk, and yet it’s one of the most important things that we do to keep Americans healthier,” echoed Rep. Jan Schakowsky (D-Ill.).
Rep. Raúl Grijalva (Ariz.), another liberal Democrat, said the Republican strategy rests on the notion that Medicaid is not as popular or important as Medicare and Social Security, and therefore makes for an easier political target. That theory, he warned, is categorically untrue.
“They don’t mention Medicaid because they don’t perceive that as a political third rail. But it is, because you’re going to see cities, states and communities across this country – and the whole health industry – react very negatively to any proposed cuts,” Grijalva said. “They’re going to get a very serious backlash.”
It’s not only blue states that have a stake in the fight. While the Supreme Court in 2012 shot down an ObamaCare provision requiring every state to adopt the Medicaid expansion, 39 states have done so voluntarily. And legislators in North Carolina announced a deal on Thursday that could make them the 40th.
In their quest to protect Medicaid, Democrats on Capitol Hill have a strong ally in Biden, who used a speech in Virginia Tuesday to warn Republicans that any proposals to cut Medicaid or ObamaCare would be dead on arrival if they reach his desk.
“Make no mistake, if MAGA Republicans try to take away people’s health care by gutting Medicaid and the Affordable Care Act, I will stop them,” he said.
Biden went after Sen. Rick Scott (R-Fla.) for proposing to “sunset” all federal programs after five years, only to add exceptions last month for Social Security and Medicare after weeks of criticism from Democrats and Republicans alike. The fact that Medicaid was not also exempted from Scott’s plan was not overlooked by the president.
“Now he says, ‘Never mind, don’t need to do that’ – although I notice he didn’t say ‘never mind’ about Medicaid and the Affordable Care Act,” Biden said.
“They’re still on the chopping block.”
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This story was originally published March 5, 2023, 6:00 AM.