Political Animal


October 29, 2012 10:20 AM The Card Left Unplayed: Medicaid

By Ed Kilgore

In his latest New York Times column, Paul Krugman makes an argument near and dear to my heart and familiar to regular readers here: the two parties’ approach to the Medicaid program ought to be a really, really big deal in this election:

There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.
But one thing is clear: If he wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.

Krugman goes on to patiently explain the Medicaid program: its central role in providing health insurance and not just to needy families with children (particularly the working poor) but also to “medically needy” seniors, including the 6 million for whom Medicaid pays nursing home bills; and its sterling cost-control record as compared not only to Medicare but to private health insurance. And he’s right: this is one of the relatively few areas of domestic policy where both Romney and Ryan have been very clear about their intentions (if not at all honest about their consequences, since they treat block grants as some sort of magic that enables already fiscally stressed states to cover more people with vastly less money).

I’d add to Krugman’s argument a simple political one: despite the CW holding that people who vote care intensely about Medicare but not at all about Medicaid, messing with Medicaid is unpopular. A Kaiser Family Foundation poll back in May showed that the sales job for Paul Ryan’s Medicaid block grant proposal wasn’t going over terribly well (per Emily Swanson at HuffPost):

The Kaiser poll finds that 60 percent of respondents would prefer to keeping the government health insurance program for low-income and disabled Americans as it is now, “with the federal government guaranteeing coverage and setting minimum standards for benefits and eligibility.”
Only 35 percent would support changing the program “so that the federal government gives states a fixed amount of money and each state decides who to cover and what services to pay for.” That suggestion is part of Wisconsin Republican Paul Ryan’s proposed 2012 budget, which passed in the House with overwhelming support from GOP Reps.

And that’s with very little attention having been paid to this topic by Ryan’s critics, consumed as they were with Medicare. As Kaiser found, a little more pushback to the block grant proposal moved even more voters:

[A]n even larger percentage of those who initially said they would favor the changes said they would be swayed to keep Medicaid in its present form by a potential Democratic argument. When told that “[o]pponents of this change say it will increase the number of uninsured, increase financial pressure on states and health care providers, and cause more low-income people to go without health care and long-term care services, particularly during tough economic times,” 26 percent of those initially in favor of the change said they would now be opposed, for a total of 25 percent in favor of block grants to states and 69 percent opposed.

If Romney wins, particularly if it’s by convincing swing voters that he’s this moderate technocrat who will just smooth off the edges of Obama’s policy agenda and apply his management acumen without radical changes in the role of government, the failure of Democrats to make a big deal out of his and his party’s health care agenda beyond Medicare should haunt progressives for a long time. The Medicaid block grant is the biggest example of a card not played, but a more intensive focus on the positive aspects of Obamacare, and also exposure of such reactionary GOP “ideas” as interstate health insurance sales (which would destroy existing state protections of people with pre-existing conditions and older and sicker Americans generally) also largely failed to make the cut in Democratic arguments about the “big choices” this election entails. And if these proposals are actually implemented, no one can say they were not warned.

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.


  • c u n d gulag on October 29, 2012 10:37 AM:

    Oh, if only our hidious MSM could only take it's eyes off of the poll numbers, AND COVER WHAT THE CANDIDATES AND THE ISSUES ARE!!!

    How about it, Upchuck Todd?

  • K in VA on October 29, 2012 10:42 AM:

    I'd say that the Romney camp's positions are the second-most-complete personification of an actual "death panel" in health care. A Romney presidency would, of course, be first.

  • Robert Abbott on October 29, 2012 10:56 AM:

    The Democrats are the ones who told a national audience in prime time at the Convention just what the cuts to Medicaid would do to Medicare and the Health Care Reform Act. Bill Clinton spelled it out it in the same terms that Krugman uses today. The President and Vice-President have repeated the facts numerous times in stump speeches, so we have nothing to be ashamed of in that regard.

  • schtick on October 29, 2012 11:01 AM:

    The teapubs have been good with their lies. Most people hear Medicaid and think welfare and think moochers taking their tax dollars because they are too lazy to work. Most of the people don't even realize everything that medicaid covers.

    crapcha....cause WhatchP....she's back?

  • Peter C on October 29, 2012 11:13 AM:

    If Romney wins (even by the tiniest margin), the Republicans will claim a 'mandate' because their agenda is so extreme. "Yeah, you voted for me because you were scared and in pain and I blamed Obama for your acne, but we mentioned that we'd gut Medicaid and voucherize Medicare and privatize FEMA and double the size of the military, AND WE STILL WON, so it's full speed ahead! Hello reconcilliation!"

  • kd bart on October 29, 2012 11:14 AM:

    Off topic but a question regarding Rasmussen. I know Rasmussen is a robo poller, which I gather means no cell phone calls, which does all of their polling in a 4 hour window that does not callback numbers that were not answered, they just call a new number. Does Rasmussen only release their toplines or do they also release their breakdowns by age, income, religion, race, etc on their polls? Even to those who pay for their service.

  • martin on October 29, 2012 11:14 AM:

    I have to disagree with schtick. I suspect when most people hear Medicaid they hear Medicare. Unless they or a close relative is using Medicaid, I think the terms are inter-changeable to the general, non-political geek population. And as Medicare is very, very popular, they interpret attacks on Medicare as a bad thing. If only the Dems wold capitalize on it.

    Great Yoteday, Captcha misspells.

  • Mimikatz on October 29, 2012 11:16 AM:

    Where is the nursing home industry in all this? The Hospital Association? Do they just expect to do a lobbying blitz on Congress if Romney-Ryan-Boehner win? Really?

    There are millions of seniors and their families who are going to be in deep distress if this comes to pass, to say nothing of the facilities where the seniors are living. But given the fate of Medicare Part C, repealed because richer seniors refused to pay to fund real long-term care insurance, maybe society really doesn't care.

    Where will the right-to-life people be when the wmedically indigent are discharged to die with their families or in their beds on the streets if they have no family? Maybe this is how we finally figure out how to save on end-of-life care.

  • stormskies on October 29, 2012 11:22 AM:

    And just ponder on this: about 90 million Americans will vote for this sadistic, psychopath, sociopath, and pig called Romney.

  • deanarms on October 29, 2012 11:40 AM:

    Most people with a job and health insurance and no real health trauma (loosely defining the "middle class") don't really deal with Medicaid. UNTIL they get old or have an elderly parent who needs extended care (eg, rehab after a stroke, nursing home care etc) and you enter the land beyond Medicare. Then Medicaid becomes very very important. Mitt is banking on that obliviousness to let him pillage Medicaid.

  • Rabbler on October 29, 2012 11:58 AM:

    So blame the progressives if the swing voters don't vote for Obama?? Would that be the progressives at the Progressive Policy Institute? I didn't think so. Starting a preemptive CYA policy already? The way those progressives smothered Obama's natural ardency in that first debate is just shocking.

  • A Democrat in a red state on October 29, 2012 12:06 PM:

    My aunt, who served in the WACs during WWII, worked all her life, into her 70s, as a beautician, has been in a nursing home for 5 years with dementia. She paid full price until the monies from the sale of her home and her savings gave out. She has been on Medicaid for the last two years. The home accepts her Social Security and Medicaid pays the rest. She receives the best of care. I agree that most people do not understand all the facets of Medicaid.

  • jim filyaw on October 29, 2012 12:12 PM:

    all true, but why is it that democratic politicians won't go out of their ways to connect the dots. its almost like the coming of the gipper and the hangover from vietnam have made 'liberal' a permanent epithet. even obama shies away from the word, and more importantly, the argument. get over it! quit worrying about being confused with a hippie. most voters nowadays have seen more ivory billed woodpeckers.

  • stern on October 29, 2012 12:22 PM:

    Wait till the Randers and the TeaPoops have to fork over $30,000+ for nursing home care and god only knows what for extended hospital stays.

    I say bring on the heart transplants! Bring on the kidney dialysis! Bring on the hip replacements! Bring on the wound therapy for dear old mom and dad.

    And don't forget your spouse's dear old mom and dad (and the deadbeat brother-in-law and the alcoholic aunt)!

    Replacement parts for one and all!

    P.S.: And don't forget comfy

  • schtick on October 29, 2012 12:47 PM:

    Actually, Martin, I think you agreed with me. A lot of people don't understand Medicaid and everything it covers. They think welfare and moochers and I should have added Medicare. And IMHO they understand none of it.