Political Animal


September 06, 2012 10:30 AM To the Aid of Medicaid

By Ed Kilgore

In the progressive takes on Clinton’s speech last night, I was impressed and gratified how much attention is being paid to the significance of the Big Dog’s discussion of Medicaid. Up until now, I’ve felt pretty lonely in excoriating Democrats for having largely ignored this topic (virtually unmentioned at the Convention, I think, until Sister Simone Campbell’s speech yesterday; even HHS Secretary Kathleen Sebelius failed to go into it). Sure, earlier in the summer there was a flurry of interest in the Medicaid expansion provided for by the Affordable Care Act, once the Supreme Court ruled it was essentially optional for the states. But the dire, immediate and unambiguous Republican determination to wreck the basic Medicaid program, and the implications for all sorts of people—including the elderly and disabled—wasn’t making it into a lot of speeches that devoted vast rhetorical real estate to the less draconian and less immediate changes Republican propose for Medicare.

Here’s Ezra Klein’s excellent summary of the significance of Clinton’s discussion of Medicaid last night:

[T]here are three things worth noting about this Medicaid section. First, it’s a direct attack on Romney and Ryan’s claim that their budget won’t harm any seniors over age 55. As Clinton notes, much of Medicaid’s spending goes to nursing home care for seniors, and there’s no way Romney and Ryan can cut the program by a third without hurting the seniors who account for the plurality of Medicaid’s spending.
Second, it’s an inarguable attack on Romney and Ryan’s budgets. There are many, many places where one or both of the Republican candidates have been vague about they actually intend to cut or change, and that’s made it hard for Democrats to mount a sustained assault on them. But both Romney and Ryan have been very clear about how, and by how much, they intend to cut Medicaid. They will block grant it, and cap its growth such that it gets about $1.4 trillion less than it would under Obama. It’s a rare instance of specificity in both of their budgets, and so it can’t be waved away by promising details that will come after the election.
Third, it’s arguably the most important and concrete policy difference between the two campaigns. The Medicare changes get more attention on both sides, but Romney and Ryan don’t intend to touch Medicare for 10 years, they swear they’ll honor the Medicare guarantee, and at least in Ryan’s most recent budget, he envisions the exact same long-term spending path as Obama does. By contrast, Romney and Ryan intend to begin cutting Medicaid immediately, and independent analyses suggest that their cuts could throw as many as 30 million people off the program. If you want to see the difference between Obama and Romney’s vision for American policy, it’s probably the single starkest example.

Right, right and right. Reading a lot of folks this morning, it’s apparent that Clinton dispelled the implicit cynicism about “poor people programs” that so often keeps progressives from talking about Medicaid other than once in a blue moon. And regardless of the impact his speech has or doesn’t have on the presidential contest, I’m grateful for that.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • Mudge on September 06, 2012 10:39 AM:

    Ezra says.."..but Romney and Ryan don’t intend to touch Medicare for 10 years, they swear they’ll honor the Medicare guarantee..". Romney and Ryan will lie about anything to get elected. I see no reason to assume this statement can be believed, I always assume their statements to be a lie to start. Any pundit who assumes Romney/Ryan are telling the truth ventures into fantasyland.

  • Robert Waldmann on September 06, 2012 11:00 AM:

    You are so so soooo right. The fear of letting middle America know we care about poor people has made many Democrats so cynical that they are stupid. Medicaid is very very popular. Opposition to cutting Medicaid is almost as overwhelming as opposition to cutting Medicare
    http://bit.ly/UuETlA (one of many many possible links).

    The reason is that not all poor people are "those people." A few months in a nursing home and a formerly middle class person is eligible for Medicaid. I'm sure many people actually know this (roughly as many as accept that Medicare is a government program).

    The Medicaid puzzle has always been how can there be a huge program for poor people in America. The reason is, sad to say, based on class. Medicaid money is not spent mostly on the underclass whose poverty is passed down generation to generation and who can be othered. It is mostly spent on the newly poor made poor by chronic disease. People can't other their mother and many know they would be paying for her nursing home care if it weren't for Medicaid.

    I am slipping towards cynicism, but the point is that Medicaid is a great program which does absolutely necessary things for poor people who have been poor all their life and it is popular because it is also social insurance for people who were doing OK but now are chronically sick. That's the ticket -- you can help the poor if the same program helps the middle class (or former middle class if one insists that class can change quickly).

    Also and totally separately, I will fight to reverse the 1996 welfare reform and especially for a 10 fold increase in foreign aid. But I will be careful to make it clear that I am arguing against the Democratic party when I do so. (can't punch hippies if there are no hippies to punch).

  • c u n d gulag on September 06, 2012 11:03 AM:

    This is an expansion of Reagan's ketchup as a vegetable, policy and Michelle Obama's campaign against childhood obesity.

    Now, every family will be guaranteed to have at least one vegetable at every meal - Grandma!

  • 57andfemale on September 06, 2012 1:38 PM:

    You're not alone. I've been screaming about this issue since Ryan was chosen. Thanks, Bill, for giving it the prominence it deserves.