Political Animal


May 09, 2011 11:15 AM The GOP puts Medicaid ‘in its sights’

By Steve Benen

The Republican plan to end Medicare, replacing it with a privatized voucher scheme, isn’t going particularly well. But the radical GOP budget plan is ambitious in a variety of areas, and the vision for Medicare isn’t the only problem.

The Hill reports that health care advocacy organizations believe “the GOP has Medicaid ‘in its sights’ as a more realistic place to make healthcare cuts.” Bruce Lesley, president of the children’s advocacy group First Focus, explained, “I’ve always worried that Medicare and Social Security would go off the table and Medicaid would be the only thing left standing.”

Those fears are well founded. The Republicans’ Medicare plan is already a flop, but as Ezra Klein explained the other day, “The attack on Medicaid … is another story.”

There are two reasons Medicaid is more vulnerable than Medicare. The first is who it serves. Medicaid goes to two groups of people: the poor and the disabled. Most of the program’s enrollees are kids from poor families, though most of the program’s money is spent on the small fraction of beneficiaries who are disabled and/or elderly. These groups have one thing in common, however: They’re politically powerless.

The second is who pays. Medicare is a fully federal program. Medicaid is a state-federal match, and it absolutely kills states during recessions, as unlike the federal government, states can’t run deficits, and so they find themselves with increased Medicaid costs because they have more people in need but decreased revenues. So there are a lot of governors — particularly GOP governors — straining under overstretched state budgets who’d like a way out of their fiscal crisis that doesn’t include raising taxes, and there are a lot of federal legislators who’d like to save money without having seniors mounting protest marches outside their office, and Medicaid begins to look like an answer to everyone’s problem.

The GOP plan isn’t just to scale back Medicaid by squeezing some additional savings out of the existing program — which is pretty much impossible at this point — but rather to turn Medicaid over to states in the form of block grants. For the feds, this would mean far less of an investment in the program. For states, it would mean a new ability to start limiting Medicaid eligibility and /or rationing health care serves for beneficiaries.

Who loses? The elderly, families in poverty, and the disabled — constituencies Republicans aren’t especially concerned with.

Medicare privatization isn’t going anywhere. Under the circumstances, Medicaid is worth worrying about.

Steve Benen is a contributing writer to the Washington Monthly, joining the publication in August, 2008 as chief blogger for the Washington Monthly blog, Political Animal.


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  • Linda P. on May 09, 2011 11:30 AM:

    Medicaid does have one potentially influential constituency: the families of nursing home patients. Most of those confined to nursing homes eventually wind up on Medicaid, as the cost will quickly erode middle class savings. If there is a significant reduction in the program, the number of available beds will shrink and families will need to assume more of the burden. Faced with a choice of paying college tuition, saving for their own retirement, or footing the bill for their parents' custodial care, many middle aged, middle class voters might come to a greater appreciation of the " welfare state".

  • c u n d gulag on May 09, 2011 11:33 AM:

    And the problem here is that the poor and disabled don't vote like seniors do.

    I hope Democrats take a stand on this issue, instead of figuring 'Hey, if I sacrifice Medicaid, I can still claim I saved Medicare and Social Security.'
    Which I'd put my money, if I had any, on them doing exactly that.

    We have a government of two kinds of people:

    Outright total f*cking scumbags,
    and weak and complicit scumbags.

  • SaintZak on May 09, 2011 11:35 AM:

    The majority of people in nursing homes end up on Medicaid, my mother did.Believe me, the Republicans are in for one very big surprise when people realize the ramifications of having their disabled old parents suddenly tossed out of their nursing home when the private funds dry up...and that doesn't take long.

  • hell's littlest angel on May 09, 2011 11:42 AM:

    Republicans vilify the poor for any number of things. The only thing they don't attack them for is the one thing that, statistically, they're guilty of: not voting.
    If Republican-run state governments can choose who to cut from the rolls, it will be children in poverty before it's seniors in nursing homes.

  • c u n d gulag on May 09, 2011 11:48 AM:

    Krugman writes about the mess we're in.

  • DAY on May 09, 2011 11:51 AM:

    A productive, vibrant, capitalist society has little use for those who do not contribute, do not "pull their own weight".

    There was a similar situation in Europe, in the 1930's and a solution was found. (For the puzzled, a hint: Jews, Gypsies, Homosexuals. . .)

    Since you have our name and email, perhaps some of us could get a "Frequent Poster Pass", and not to endure the ignominious Captcha Patdown!

  • jonas on May 09, 2011 11:53 AM:

    The above commenters are right: the biggest constituency for Medicaid is nursing home patients -- particularly those with dementia, Alzheimer's, etc., whose care costs thousands of dollars a month. Also, a lot of people don't realize that Medicare does not cover long term convalescent care and that the only way most people pay for it is to spend (or bequeath) themselves into poverty so they qualify for Medicaid.

    Medicaid also pays for health care for hundreds of thousands of children in the foster care system, many of whom suffer from serious physical and psychiatric illnesses related to drugs (parental use), violence and abuse, neglect, etc.

    A realization is dawning on people across America: the GOP won't tax millionaires or oil companies to help our budget situation, but they're happy to throw granny and orphans out on the street. Glibertarians think this is only fair -- the orphans and elderly should have had the foresight to be richer -- but most Americans will find it enormously unjust, unfair and unamerican. Not to mention that it threatens to completely destroy what's left of the middle class.

  • rikyrah on May 09, 2011 11:54 AM:

    the highest percentage of Medicaid dollars go to the following:

    1. Senior Citizens in nursing homes.
    2. Disabled adults

    There are a whole lot of middle-class White folks whose parent(s) are in nursing homes paid for by MEDICAID.

    they better wake the fuck up.

  • zeitgeist on May 09, 2011 11:57 AM:

    Oh please GOP, don't make us run TV spots with disabled children in their wheelchairs in them. Or saddened families at Grandma's nurshing home bedside. Because I really hate the appearance of exploiting the disabled, but if that is what it takes to protect them from you being greedy, amoral pricks well. . . lights, camera, action!

  • bdop4 on May 09, 2011 12:10 PM:

    Attacking Medicaid is IMMORAL and hurts the most vulnerable among us.

    Those who would prefer to cut taxes for the rich over keeping the poverty-stricken ALIVE are IMMORAL.

    It's time to get personal and go after these bastards.

  • Texas Aggie on May 09, 2011 12:20 PM:

    Here in Texas Gov. Goodhair started the assault on Medicaid long ago. He cut thousands of kids off the rolls, made the enrollment procedures almost impossible to get through, and now requires people on Medicaid to sign up every six months or lose eligibility. He tried privatizing the enrollment procedures but found that it cost too much and the people he hired had no idea what they were doing. (Among other failures, they had applicants fax their applications to a storehouse in Seattle.) That one cost the state millions of dollars.

    Steve, please, return to a colored, restful background instead of this white glare, and dump the captcha.

  • Bob on May 09, 2011 12:27 PM:


    I'm not so sure I agree with Ezra Klein that ALL Medicaid beneficiaries are among the politically powerless.

    First, the disabled have powerful support/interest groups. Moreover, the 9 million disabled beneficiaries plus their families come from across the political spectrum. The cost of their care is so expensive there is no way most individuals and/or their families could afford it otherwise.

    Another 6 million, plus families, are elderly dual enrollees (with Medicare). Much of their cost is going to long term care that - again - they or their families cannot afford without Medicaid. Nursing home operators will not be happy with those looking to cut.

    So, at a minimum, there are 15 million beneficiaries and probably an additional 25 million (WAG) other family members who will be financially devastated and seriously pissed-off by these cuts. And there is no way to lower Medicaid costs without seriously cutting benefits for these groups as they represent 2/3 of all expenditures.

    It may not be a "third rail" but it could be a misaligned track that wrecks the GOP train.

  • N.Wells on May 09, 2011 12:46 PM:

    Oh goody, state-level death panels everywhere. Also, those impoverished kids should have worked harder at being born to rich parents, so the heck with them. (/snark)

    I swear that modern R's are making John Birchers of four decades ago look wise and compassionate in comparison.

  • j on May 09, 2011 1:04 PM:

    Well as we all know the patron saint of the GOP was Ayn Rand (who ended up on social security and medicare).

  • Anonymous on May 09, 2011 1:07 PM:

    the highest percentage of Medicaid dollars go to the following:

    1. Senior Citizens in nursing homes.
    2. Disabled adults

    There are a whole lot of middle-class White folks whose parent(s) are in nursing homes paid for by MEDICAID.

    they better wake the fuck up.

    Don't worry. They will. The only ones who never wake the fuck up are the Republicans who are utterly clueless about the constituency of their base. Thank God for the Heritage Foundation and Conservative Welfare. If they had real thinkers in their think tanks Democrats would be in real trouble.

  • Ron Byers on May 09, 2011 1:09 PM:

    Strange, the new version of Political Animal lets you post anonymously.

  • Howlin Wolfe on May 09, 2011 1:21 PM:

    These are the incoherent ideologues who are anti-abortion without question, but care not a whit what happens to the precious Fetal-American after he or she is actually born, and not only don't support making contraceptives available to women, but actively oppose artificial contraception in many cases.

    I wish we could rub their noses in their oxymoronic beliefs, so they could actually feel the cognitive dissonance it should create. It would help if the corporate media weren't so corrupt, and would point these types of things out. Unfortunately, the media peacocks could use a good nose rubbing, too.

  • max on May 09, 2011 2:33 PM:

    Just keep reminding voters that the Medicaid nursing home benefit under Medicaid will disappear under Ryancare. Got $30,000 a month for that lying around?

  • KJ on May 09, 2011 2:36 PM:

    Ditto about nursing homes and the families that will need to support those in nursing homes. Caring for an elderly disabled person is an around the clock job- so, who is going to pay for the full time care taker? Who is going to quit their job to take care of that person?

    As for children... Japan used to give flu shots to children, they changed their policy and gave the flu shots to the elderly, the number of flu cases increased substantially. I doubt the general population is going to be able to identify this trend, but it exists.

  • zandru on May 09, 2011 3:41 PM:

    As N.Wells suggests, it's time to bring back the "death panels" accusation - only this time, from Democrats at their Republican colleagues.

    Seriously - "death panels" got great public acceptance, with no evidence at all AND Democrats have actual pictures. Lots of folks in Arizona are either on Healthcare Death Row, if not already deceased, due to Gov Brewer's budgetary decrees. There will be more from Wisconsin as BadgerCare is eviscerated by Gov Scott Walker.

    Democrats need to find these folks, get their stories, and put them on the air. Ads, Youtube, the talk show circuit - "These are a few of the victims of Republican death panels. Expect many, many more as Republicans unravel and abolish Medicaid. Why were these children, these grandparents singled out? They were very sick and just not wealthy enough to be sick in the Republican Party's America."