Sen. Jay Rockefeller (D-WV) is worried about Medicaid, and with good reason. He explained last week to Ezra Klein.
"The safer Medicare is, the more endangered Medicaid is," sighs Sen. Jay Rockefeller. "Reading the tea leaves and being in a lot of meetings over the last couple of days, I worry that people are saying, ‘great, now we can really cut into Medicaid.' "
That shouldn't be the case. Medicaid is a bigger program than Medicare, serving more than 50 million people, to Medicare's 48 million. Nor does it poll substantially worse. A recent Kaiser tracking poll found that 88 percent of Americans wanted either no reduction or small reductions in Medicare funding. At 83 percent, Medicaid was close on its heels. And given those poll numbers, both programs should be bulletproof....
So Rockefeller, the chairman of the Senate Finance Committee's Subcommittee on Health Care, is trying to make some noise. Earlier today, he sent the administration a letter signed by 37 Democrats opposing the Republican budget's changes to the program. Four other Democrats sent their own letter. That makes 41—a filibuster-proof block. "That'll surprise people," he says. "Now, signing a letter is easier than casting a vote. But in government, if you float something out there and people don't say much, people mistake that for acquiescence. I think this is getting to be the time where people are going to start fighting back."
He's got reason to be concerned about Medicaid, even within his own caucus, despite the fact that 41 of his colleagues signed onto that letter to the White House. While he has, for now, enough to block cuts, that support could have some weaknesses.
They may have reason to worry. Some of the Democrats who didn't sign a letter aren't exactly voicing rock-solid opposition to Medicaid block grants, and at least one—Joe Manchin of West Virginia—is suggesting he could support them.
"The good news is that there are 41 people" who signed the letters, one Medicaid advocate told POLITICO. "The bad news is it took them a long time to get there, and it took a lot of effort to get them there."
The filibuster-proof 41 signatures prove that a large-scale Medicaid overhaul is not likely to pass. But a close look at the letters shows the program is vulnerable to other changes.
The letter doesn't mention Republican attempts to repeal Medicaid's maintenance of effort provisions, which bar states from paring back Medicaid eligibility standards. If such a vote were to come up in the Senate—or in budget talks—it may be a difficult proposal for some moderate Democrats from budget-strapped states who are up for reelection in 2012.
"It's definitely noteworthy," the Medicaid advocate said. "MOE is a little more controversial.… I think they didn't put it on there for a reason. It would have been harder to get 41 signatures."
The absence of 11 Senate Democrats and Connecticut independent Joe Lieberman from the letters is another noteworthy omission.
The list of Democratic senators who didn't sign onto the Medicaid letters includes a few heavyweights, such as Majority Leader Harry Reid, Senate Finance Committee Chairman Max Baucus of Montana and Budget Committee Chairman Kent Conrad of North Dakota. Spokesmen for their offices did not return requests for comment, but advocates believe the top senators stayed out of the Medicaid fray because of their involvement with budget negotiations.
The White House has strongly defended Medicaid against the Republicans' block grant program included in their budget, but this less-than-absolute support for not making other cuts to the program could make it easier for the Biden negotiations to slide on it.
Which would be counterproductive, from a budget perspective. Medicaid is an extremely efficient and cheap (for healthcare delivery) system. Eroding it will not only potentially hurt the million of participants in the program, but undercut implementation of the Affordable Care Act.