Dem
47
GOP
53
The Congressional budget resolution calls for cutting Medicaid by $880 billion over the next 10 years. Poll after poll and interview after interview show that this would be very unpopular. But to get a bill though the House, huge cuts in Medicaid, Medicare, Social Security or defense might be needed to placate the Freedom Caucus. Republicans are scratching their heads about how to pull this off without getting wiped out in 2026.
They think they may have the solution: gimmicks. In other words, rather than direct cuts to the budget, which would infuriate voters, use tricks that are down in the weeds that no one understands they will save money in sneaky ways. The leading plan at the moment is a per capita cap. Huh?
Medicaid is a program in which costs are shared by states and the federal government according to a fixed formula. For Medicaid expansion states, the feds pay 90% and the states pay 10%. It is an open-ended program, so Uncle Sam's contribution depends on what the states spend. The new idea that congressional Republicans are bandying about is to limit how much federal money can be spent on any one enrollee in a year. Since the amount of care is unlimited, the states would have to make up the difference, which would give them incentives to limit care, change the rules about what is covered, reduce payments to providers, etc. With enough magic, the projected federal savings could be made to look like $880 billion. As a side benefit, if most of the red states enthusiastically cut benefits for chronically sick people, those people may migrate to blue states that haven't cut benefits, saddling the blue states with extra expenses. It's a twofer! It's also pretty reprehensible. The Bible that so many of these folks thump must be different from the copy we have; ours has a bunch of (commie?) verbiage about helping the sick and poor. They must be using the $60 King Donald version manufactured in Hangzhou, China. (V)