The Anti-Medicaid Bomb in the Republican "Health Care" Bill

Tom Toles/Washington Post (source)

by Gaius Publius

Just one more note on the Senate "health care" bill, to add to the information you're already reading. Via Robert Reich, the bill's real aim is the destruction of Medicaid (see explanation below), one of the three great social programs passed by FDR and his fervent New Deal acolyte, LBJ.

There's a trick with the Medicaid death trap though — most of the destruction is timed to occur after the CBO's 10-year analysis window, which means it's not going to show up when the CBO scores the bill.

Will Americans be fooled? Who knows? Will Republicans think Americans will be fooled? Likely.

Here's Reich on that (h/t Naked Capitalism; source RobertReich.org; emphasis mine):

The Secret Republican Plan to Unravel Medicaid

Bad enough that the Republican Senate bill would repeal much of the Affordable Care Act.

Even worse, it unravels the Medicaid Act of 1965 – which, even before Obamacare, provided health insurance to millions of poor households and elderly.

It’s done with a sleight-of-hand intended to elude not only the public but also the Congressional Budget Office.

Here’s how the Senate Republican bill does it. The bill sets a per-person cap on Medicaid spending in each state. That cap looks innocent enough because it rises every year with inflation.

But there’s a catch. Starting 8 years from now, in 2025, the Senate bill switches its measure of inflation – from how rapidly medical costs are rising, to how rapidly overall costs in the economy are rising.

Yet medical costs are rising faster than overall costs. They’ll almost surely continue to do so – as America’s elderly population grows, and as new medical devices, technologies, and drugs prolong life.

Which means that after 2025, Medicaid will cover less and less of the costs of health care for the poor and elderly.

Over time, that gap becomes huge. The nonpartisan Urban Institute estimates that just between 2025 and 2035, about $467 billion less will be spent on Medicaid than would be spent than if Medicaid funding were to keep up with the expected rise in medical costs.

So millions of Americans will lose the Medicaid coverage they would have received under the 1965 Medicaid act. Over the long term, Medicaid will unravel.

Note that date — after 2025. That means that the bulk of the damage will occur outside the 10-year window of the Congressional Budget Office's typical analysis.

Reich again:

Does anyone now know this time bomb is buried in this bill?

It doesn’t seem so. McConnell won’t even hold hearings on it.

Next week the Congressional Budget Office will publish its analysis of the bill. CBO reports on major bills like this are widely disseminated in the media. The CBO’s belated conclusion that the House’s bill to repeal and replace the Affordable Care Act would cause 23 million Americans to lose their health care prompted even Donald Trump to call it “mean, mean, mean.”

But because the CBO’s estimates of the consequences of bills are typically limited to 10 years (in this case, 2018 to 2028), the CBO’s analysis of the Senate Republican bill will dramatically underestimate how many people will be knocked off Medicaid over the long term.

Which is exactly what Mitch McConnell has planned. This way, the public won’t be tipped off to the Medicaid unraveling hidden inside the bill.

The long-term goal? To entirely delete the New Deal from U.S. social policy. This is step one:

For years, Republicans have been looking for ways to undermine America’s three core social insurance programs – Medicaid, Medicare, and Social Security. The three constitute the major legacies of the Democrats, of Franklin D. Roosevelt and Lyndon Johnson. All continue to be immensely popular.

Now, McConnell and his Senate Republican colleagues think they’ve found a way to unravel Medicaid without anyone noticing.

Don’t be fooled. Spread the word.

The wicked plan might just work.

The Neoliberal Republican End Game

Have you ever wondered what will happen in this country if right-wing neoliberalism ("free market economics" in its most aggressive form) ever succeeds absolutely?

Imagine repealing...

• The entire U.S. regulatory state
• Social Security
• Medicare
• Medicaid

...in a single two- to four-year span. Would the country not tip into chaos of the most unimaginable sort at that point?

And would Paul Ryan care? There's a word for behavior like this, and it applies perfectly.

I personally think Republicans like Paul Ryan would sacrifice any Republican chance of holding office for a generation if they could accomplish that transformation. Once destroyed, the New Deal government, as degraded as it has become, would never ever be rebuilt, even in the lifetime of the last person born tomorrow, were she to live to the age of ninety, and even if the Democrats achieved the kind of Congress and mandate Obama enjoyed in 2009.

The New Deal would fall to the floor of the historical past, never to rise in this country again.

And every Republican who helped pull off this coup, if they could do it, would be so richly rewarded by the Kochs of the world, they'd never need to work for a living again. They could float to their graves on Thank You money, enjoying government-paid health care right till their final breath.

Will they succeed? Who knows? But they're giving it their very best shot, and they have the votes in the Senate if they can get the Susan Collins of the world ("I vote Republican, but only when it matters" ) to cast them.

Will Democrats succeed in blocking them? They had better be giving it their very best effort. The next "designated Democratic villain" to step out of line — looking at you, Manchin and Heitkamp, McCaskill and Coons — might just be signing the death warrant for the entire rest of the Party as she does it.

GP