Social Security and Medicare are off the table in debt ceiling talks, Barely Speaker Kevin McCarthy keeps insisting. Let’s give him the benefit of the doubt and assume he means it, and that he can somehow convince the maniacs who really have the power in the House that going after the programs is a loser for them. Yes, that’s granting him a lot of benefit that he’s done nothing to earn, but we’ll suspend disbelief for now.
McCarthy still has to fulfill a promise to them—a balanced budget in 10 years’ time. It’s a bullshit promise, but that’s what they all agreed to in their ballyhooed rules package. If Social Security and Medicare are left out, and so are defense and veterans spending because they’re sacrosanct, just everything else would have to be zeroed out to achieve the goal. Oh, and they won’t raise taxes.
Just because what they say they are going to do is impossible, it doesn’t mean the GOP isn’t going to go after the low-hanging fruit that they regularly target for cuts: Medicaid. Because it’s such an obvious target, now we be a good time for Democrats to add it to the rhetorical list of things that they’re not going to be negotiating with Republicans.
Total Medicaid spending for 2021 was nearly $750 billion, including federal, state, and administrative costs. More than $500 billion of that was federal money. That’s a lot of money, but that big chunk of change provided coverage to more than 80 million people, including children in the CHIP program. That’s more than are enrolled in Medicare.
It’s also low-hanging fruit in a program that Republicans have been trying to cut since it was enacted in the 1960s. One tried and thus far unsuccessful efforts dates back as far as the Reagan era, when Republicans started trying to turn it into a block grant program. Instead of being an open-ended program, spending as need required, it would get a predetermined chunk of cash, and once that was spent it would be done until the next year’s appropriation.
The Romney/Ryan campaign back in 2012 featured reshaping the program that way. More recently, Donald Trump took a stab at it, putting through a waiver that would allow states to take the money as a lump sum. Tennessee was the only state to take Trump up on it, with a waiver approved as a parting gesture by the Trump administration. In 2020, during a pandemic, when emergency health care funding was absolutely critical. The Biden administration promptly put that on hold.
Then there’s the old favorite way of punishing people who need help: work requirements. House Majority Leader Steve Scalise hinted at that idea last week, when he sort of whiffed on the Social Security question, but was possibly thinking about Medicaid: “We want to strengthen Social Security by ending a lot of those government checks to people staying at home rather than going to work.”
Rep. Matt Gaetz (R-FL), who made McCarthy’s path to the Speaker’s chair so difficult, has been banging this particular drum with his colleagues. He wants forcing work requirements on Medicaid to be ransom in the House GOP’s debt ceiling hostage-taking.
“Work requirements are proving to be a very unifying concept with my colleagues,” he told Semafor, saying he had “a very positive reception,” including with McCarthy. He wants all the “able-bodied working-age adults” who are in the states that expanded Medicaid under the Affordable Care Act to be working, saying that would help fix labor shortages. Except, of course, that’s bunk.
Here’s North Carolina Republican State Senator Phil Berger, who recently told PBS that he’s a convert to expansion, after spending years opposing it.
“The reality is that, with the way the federal program is designed, more often than not, what you have is a situation where folks who would be eligible for Medicaid in the expansion population are people that are actually working full time. Sort of the person that seems to be helped the most would be a single female with one or two children who works a full-time job. […]
“So, I actually think that, at this time, a substantial number of the people that will be covered in the expansion population are people that are actually working.”
Health care wonks have known that for years. The problem isn’t lazy people trying to sponge for free health care. It’s an increasing number of people whose jobs don’t provide health insurance and who can’t afford it on their own. The changes the Biden administration has made to eligibility of subsidies under Obamacare has helped to bring some of these folks into coverage, but there’s still a gap—people who are working and can’t get covered.
Also, it doesn’t work to force people into work. Arkansas tried that under Trump, instituting work requirements in 2018 that were blocked by a judge in 2019. It made life a lot more difficult for a lot of people, a follow-up study from Health Affairs found, but didn’t increase employment. “[P]eople in Arkansas ages 30–49 who had lost Medicaid in the prior year experienced adverse consequences: 50 percent reported serious problems paying off medical debt, 56 percent delayed care because of cost, and 64 percent delayed taking medications because of cost.”
Not that any of that makes any difference whatsoever to Republicans. Because the suffering is the point.
How can you tell when a poll is actually high quality? Natalie Jackson, research director at PRRI, joins us on this week's episode of The Downballot to discuss that and more. Jackson tells us the indicators she looks for to determine whether a survey is worth taking seriously, what she thinks the future of polling aggregation ought to look like, and why white evangelical Christians are the real outliers when it comes to religious groups' views on abortion.
Co-hosts David Nir and David Beard also break down Democrats' big special election victories in Pennsylvania; new efforts by progressives to pick their preferred GOP opponents in two key Wisconsin races; the first true retirement from the House this cycle; and a proposal to increase the size of the House, which has been capped at 435 members for more than a century.