There was new talk among key GOP figures about wooing moderates by altering the bill’s Medicaid changes, according to two people involved who would not speak publicly. By tweaking how federal funding is determined for Medicaid recipients and linking aspects to the medical component of the consumer price index, there is a belief that some moderates could be swayed, because they want assurances that funding would keep up with any rises in the cost of care, the people said.
Then would come the tightrope: If some senators can be persuaded to support revisions to the Medicaid portion of the bill, several conservatives are warning that unless their amendments are also included, they are unlikely to support the legislation. The hope is that a combination of those Medicaid changes and amendments from conservatives could pave the way to passage.
Unless the Senate eviscerates the part of the bill that GOP hard-liners like — cutting Medicaid to pay for big tax cuts — moderates will have a hard time explaining how ending the federal match for Medicaid expansion (even at a slower pace) and providing less money on an inflation-adjusted basis doesn’t violate their promise.
It would be one thing if hard-right and moderates had said: We think spending less money or giving states more flexibility is more important than covering everyone who is now guaranteed coverage. But they and President Trump promised “no one” would lose coverage, and there would be “no cuts” to Medicaid. The Senate bill plainly does not meet those ends. Rather than continue to lie about what the bill does and doesn’t do, they should be compelled to make the argument on the merits. What is the argument for taking more than $800 billion out of the Medicaid system in order to spare the super-rich some taxes — before turning to tax reform and driving their tax liability down even further?
We have some specific questions for lawmakers who should consider how the bill specifically impacts their states:
Sen. Marco Rubio (R-Fla.): You helped block most payments to insurers going through the risk corridors to compensate for excessive losses. Do you admit that this was a significant reason the exchanges have lost many insurers (in some cases, all of them)? Why would you support a bill now that explicitly makes the very same payments to insurers for two years that you sought to block? Oh, and how many Floridians in nursing homes or assisted-living facilities (AFLs) rely on Medicaid? (I will save him the trouble: “There are 683 licensed nursing homes in Florida, representing approximately 83,587 beds … [and 3,089 licensed AFL’s in Florida, representing approximately 92,000 beds.] … Medicaid, which covers health care costs for low-income individuals, pays for approximately 60 percent of all long-term care spending.”)
Sens. John McCain (R-Ariz.) and Jeff Flake (R-Ariz.): You have rightly pointed to huge premium increases in your state exchange as evidence that Obamacare is not working. But why then turn the bill into a jumbo tax cut for the rich and cut back on Medicaid? Gov. Doug Ducey (R) “wants a slower phase-out of higher Medicaid expansion matches, higher inflation adjustments, elimination of a penalty for states that expanded parts of Medicaid early, and explicit flexibility for the program covering 1.9 million Arizonans.” He says the Senate bill would cost the state $7 billion. (“Currently, approximately 400,000 Arizonans receive coverage through Medicaid. Changes to federal matching payments for the state’s 1.9 million Medicaid recipients would cost $2.9 billion. Limiting inflation adjustments would cost $2.2 billion. Another $2 billion loss would occur when a hospital assessment that pays the state costs of covering 82,000 people in the expanded program and 319,000 childless adults stops. That will happen in 2022 when federal matching rates hit an 80 percent trigger in the 2013 state law authorizing expansion. Raising taxes to replace the money is unlikely in a Republican-controlled state.”) If he’s right, will you vote against the bill?
Sens. Bill Cassidy (R-La.) and John Kennedy (R-La.): Louisiana belatedly expanded Medicaid. More than 400,000 enrollees were added. Louisiana Gov. John Bel Edwards (D) strongly opposes the Senate health-care bill. It’s easy to see why: “In Fiscal Year 2017, Louisiana has saved an estimated $200 million from expanding Medicaid. In the fiscal year that begins on July 1, 2017, the state is expected to save more than $300 million. Without these savings, K-12 education, higher education and health care would be forced to shoulder deep cuts in the state budget.” Can you explain, senators, how the Senate bill will impact Louisiana residents? Will the state raise taxes to make up revenue it loses from the feds? No, I didn’t think so.
Sens. Shelley Moore Capito (R-W.Va.) and Rob Portman (R-Ohio): Your states are at or near the top of the list of states with the most opioid-related deaths. At the end of 2016, the Centers for Disease Control and Prevention released data showing that “in 2015, the five states with the highest rates of death due to drug overdose were West Virginia (41.5 per 100,000), New Hampshire (34.3 per 100,000), Kentucky (29.9 per 100,000), Ohio (29.9 per 100,000), and Rhode Island (28.2 per 100,000).” Have you asked your state governor how many fewer people would receive treatment and what that might do to the death rates? (Even if the GOP leaders sweeten the pot by throwing in more money for opioid treatment, you do realize this does not guarantee that sufficient funding will be there, don’t you?)
Just three of these senators (two, if you think Sen. Rand Paul is a certain “no”) can stop the bill. They would be wise to tell their colleagues that this is not the time to whack Medicaid. If their colleagues want to talk about repairing the exchanges, the senators should offer whatever ideas they have and invite Democrats to join. But other than lust for revenue for tax cuts, there is no reason to address Medicaid now. On that, a bipartisan commission of governors could come up with a list of proposals (some governors already have). If, however, they allow the party to turn “repair and replace Obamacare” into a raid on Medicaid, affecting the most vulnerable people in their states, they’ll never live it down. Frankly, I don’t know how they could even sleep at night.