A friend of mine sat in on the
Families USA conference call on Medicaid cuts. The full audio from the call is supposed to be posted to the website soon. A summary of the call is in extended.
Basically:
- There will be $10 billion in Medicaid cuts.
- The cuts will be made within a reconcilliation bill which cannot be fillibustered.
- Bush may appoint a sham Medicaid "commission" (remember social security?) to "study" Medicaid.
- Bottom line: These cuts are a way for the feds to do more cost-shifting to the states.
See a complete summary of call in extended.
First: What WE Can Do
What we can do:
-- In the next couple of months, or SOONER, the Senate Finance Committee and the House Commerce committee will have to reconcile the House and Senate bills. We would accept a bill that produced cuts by allowing negotiations for prescription drugs and cut GENUINE waste, fraud and abuse.
-- What we will GET is likely to be a bill that changes the cost-sharing formula, entitlement formulae, block grants the whole program, etc. These are very bad for Medicaid.
-- We MUST come together on our ideas for cutting the $10 billion, otherwise we're sure to get awful choices.
-- The Center for Budget and Policy Priorities, Families USA, and other groups, will try to lay down lines that can't be crossed, cuts that are very harmful to Medicaid. Send feedback to Families USA with suggested non-harmful cuts. Mail to: Medicaid@familiesusa.org
It's critically important for residents of the states of Senate Finance Committe members to emphasize to their Senators that certain kinds of cuts must not happen. We also need support from as many other Senators as possible. Tell
Senators do NOT vote for the budget reconciliation bill if it contains harmful cuts to Medicaid.
-- The budget resolution in the Senate only passed 51-49. The reconciliation bill also faces tough sledding. If the bill passes the Senate, it goes BACK to conference, where House members are NOT our friends and will want deep
strucural cuts to Medicaid
-- The good news is that the $10 billion in cuts are much better than expected (or than originally planned by the Bush administration) because of the
work of activists like Families USA and others.
---Conference Summary: ------------------
- There will be $10 billion in Medicaid cuts. We should work with Families USA to come up with a list of Medicaid cuts we find tolerable or acceptable to prevent worse results.
- The Medicaid cuts will be made within a budget reconcilliation bill which by law cannot be filibustered. [Bush's plan to make sure to get all this by Congress].
The best chance we have of influencing the outcome is to persuade state senators to vow in advance to vote against the conference reconciliation bill if
there are unacceptable, structural cuts in Medicaid. We should also contact members of the Senate Finance Committee.
3. Bush will likely pretend to accept the Smith/Bingaman idea of appointing a commission to study Medicaid, but instead of the broad-based bipartisan commission, will likely appoint a hand-picked sham commission. If that happens,
we must shoot down the credibility of this type of commission as soon as it's appointed.
4. Talking point: These Medicaid cuts are simply a way for the federal government to do more cost-shifting to the states, causing deep cuts in other state programs, tax increases, or both.
-------------------------------------------
Conference details:
Speakers: Ron Pollack, Rachel Cline
I. What the budget resolution says about Medicaid cuts:
-- approximately $10 billion must be cut from Medicaid over the four years from 2007 to 2010.
-- activists have already reduced the potential harm to Medicaid by our activism
-- from here on, our work is critically important
-- a budget resolution is a set of guidelines. This year they have more "bite" because they contain reconciliation instructions to the committees of jurisdiction. These instructions say the committees MUST come up with $10 billion in cuts from social service budgets. Social Security is off the table for now. Medicare is probably off the table as well because there's so much opposition from both sides of the aisle to the Medicaid bill as it was passed last year. The administration doesn't want to open up the bill for fear their
whole costly prescription drug program will be dismantled.
-- In the Senate, Sens. Gordon Smith and Jeff Bingaman's bipartisan amendment to strip Medicaid cuts from the budget resolution won 52-48.
-- The House passed a budget resolution to the Energy and Commerce committee, the committee of jurisdication, requiring cutbacks in Medicaid of $20 billion.
-- In the House, Rep. Heather Wilson (R) passed an amendment voted for by 44 Republicans to create a bipartisan study commission starting this year, and hold off making any Medicaid cuts until the results of the commission are in.
-- Sen. Smith (R) had lots of support from senators but intense pressure from the administration and party leadership forced a compromise in the Senate Finance Comm. to cut $10 billion.
Bottom Line:
---Within the next few months, the committees of jurisdiction will develop a resolution consistent with their instructions to cut $ 10 billion from social programs. The cuts COULD come out of SSI or the EITC, where we also don't want to see cuts, but most likely will all come from Medicaid.
-- A reconciliation bill, by law, can't be filibustered. To pass the entire budget with the Omnibus Budget Reconciliatioin Bill, both the House and Senate must agree to the bill coming out of the joint reconciliation committee and then members of both houses must agree to pass it. [If past history holds, the "joint" conference committee will meet at secret times in secret places, excluding all Democratic conferees. That has become routine operating procedure for Republicans, especially on contentious bills.
---MEDICAID COMMISSION-------------------
Ron: Will a Medicaid Commission be created? Probably, but what Sens. Smith and Bingaman called for won't happen. They called for a bipartisan process with members appointed by party leadership of both parties along with a representative "stakeholders" panel including providers, governors, state legislators, and Medicaid beneficiaries. The administration has already said NO.
They will almost certainly appoint their own sham commission selected for adhering to the administration's pre-ordained conclusions.
We must blow up the credibility of this sham commission from the outset! We must speak out immediately, and very strongly!
-- Smith and Bingaman recommend that the committee process be guided by the Institute of Medicine, a nonpartisan professional group. The longterm committee timeline is probably about 18 months, which is very reasonable, but Ron predicts the Bush administration will demand results and recommendations for Medicaid cuts within three months in time for the reconcilliation bill considerations. The goal will be to legitimize far-reaching structural change in Medicare that will be disastrous for recipients and states alike.
-----------------
Additional Questions from audience:
Q: . A reminder that 44 Republicans in the House voted with us. A bit educational job is needed on House members of the Energy and Commerce Committee.
Ron: We should focus hard on the Senate, where we have a chance. Especialy the Senate Finance Committee.
Q: If Congress takes over longterm care (under the new Medicare bill), Medicaid would be better off. Maybe governors will suggest it. Ron: We may not end up as alies with the state governors. This is a longterm issue.
**Ron: Send letters to Sec. Leavitt (copy Smith, Bingaman and other Senators? M) about how the Medicaid study commission is created. We want a commission established through the Institute of Medicine, not a sham commission put together by the Bush administration.
Q: Sen. Santorum WANTS massive cuts inMedicaid, claiming the cuts won't actually harm anyone, they'll merely trim waste, fraud and abuse.
Ron: The charge of "waste, fraud and abuse is the refuge of scoundrels." It's merely a pretext for massive cuts. There's legitimate waste, fraud and abuse we could advocate getting rid of, BUT we will NOT be using that as a public message because studies show "waste, fraud and abuse" is something the public already believes exist in every welfare-type program for the poor, and no
matter what we said on the subject, waste, fraud and abuse would be all they'd hear. That's a very negative message for us.
Talking point: We should say, publicly, that the massive cuts to Medicaid merely shift the burden from the federal government to the states, meaning less money for the states and more burden on the states' residents.
Q: A questioner asked about something that sounded like F2HC. He was referring to enhanced reimbursement for Medicaid, such as the program NJ has - a program that could have to stop under massive cuts to state budgets. The aid goes to places such as community health centers. Bush boasts of increased direct grants to such centers, but the Medicaid $ are FAR more important in
keeping the CHC's up and running. They'd be greatly harmed by cuts.
---------------------
Coming together on how to best reach the required level of cuts
Q: Would it make sense to push for tax incentives to purchase long term care insurance?
Ron: The House Ways and Means Committee underBill Thomas may get into this
by broadening the discussion of Social Security to include retirement, longterm care, etc. The SS argument by itself is sinking fast so Republicans will try to make the discussion as broad as possible. We could try to place the burden of longterm care elsewhere than on Medicaid, but be wary of tax policy re: longterm care. It will probably be regressive and help only those who are
already well off. In addition, it slashes government revenues still more, displacing more of the burden on the middle class.
--------------
Ron: Be aware the conference committee is inimical to our side. Our only leverage is after the conference committee comes out with their recommendation. We must convince Senators to oppose the entire bill if there are major,
untenable cuts to Medicare, especially structural changes. Senator Gordon Smith, Olympia Snowe, DeWine, Specter and Chaffee are likely to be with us with enough urging. (There may also be others whose names I didn't catch. ) The conference committee will listen to their Republican colleages who promise a "no" vote on the whole budget bill if there are severe Medicaid cuts.
What are Bush and Congressional leaders' top priorities?
1 - They MUST pass this bill.
2 - They MUST hit their target dollar cuts.
How Medicaid is changed is of less importance to them than either of the above. If our supporters aim to keep cuts from hurting beneficiaries in ways x, y, and z (which we'll talk about and decide on), we have a chance . . . .
Q. Can we work to move state governors in a helpful way? Governors have a lot of credibility with members of Congress, but many governors, even "ours," want more "flexibility," and that's NOT good for us. We would have to convince not only individual governors but the National Governors' Assc., which must agree by a supermajority vote.
Let Ron know if we can get our state's governor on board