Dem
47
GOP
53
There are some Republicans in the House who want the federal budget slashed, bigly. Not an easy task, and made harder when a political party is also pursuing fat tax cuts. Given where the lion's share of spending takes place, serious budget cuts can only be achieved by significantly reducing spending on: (1) the military, (2) Social Security, (3) Medicare, or (4) Medicaid. The first option is a nonstarter for Republicans, and the second and third options are basically nonstarters for everyone, since senior citizens tend to, you know, vote. That leaves Medicaid.
Just because Medicaid is the lowest-hanging fruit, however, does not mean it is actually low-hanging fruit. A lot of people, including a lot of people in red states, depend on Medicaid. Also, at least some members of Congress have figured out that bacteria and viruses do not check a person's insurance card, such that if sickness is allowed to run rampant among non-insured people, it will inevitably cross over to insured people. So, the system ends up bearing serious costs due to the uninsured, even if it's indirect.
Over the past month or so, Republicans in the House have bandied about various Medicaid-cost-cutting ideas that would have amounted to a pretty direct assault on the program. The one that got the most oxygen was a plan to impose a cap on the amount that the federal government would pay for each beneficiary. That was not well received within the halls of Congress, or without.
And so, House GOP leadership now has a more... sneaky approach. What they want to do is require recipients to prove that, if they are "able-bodied adults without dependents," they are meeting "community engagement requirements." This is NewSpeak for "you have to have a job if you want Medicaid." They also want to compel states to engage in much more aggressive screening, and much more frequent audits of eligibility for each recipient.
All of this is meant to make it seem as if the Republican proposal will save money by cutting fat and getting goldbricks off the dole. However, this is much like the voter ID laws that are allegedly, but not really, about voter fraud. Most Medicaid recipients who are able to work are already doing so. And studies have shown that stricter screening and more frequent auditing do not actually serve to meaningfully reduce fraud. What's really going on is that the more hoops the government throws up, the more people will struggle to jump through those hoops. Maybe it's a lack of time, or energy, or fluency, or whatever, but the current proposal will serve to kick a lot of people off of Medicaid who SHOULD be eligible. The Congressional Budget Office has already scored the proposal, and estimated that 8.6 million people would lose health insurance, increasing the number of uninsured people in America by 30% in one fell swoop.
Readers will notice that we have put "plan" in quotations in the headline. That is because while the proposal certainly qualifies as a plan, the statement "Republicans have a plan" somewhat implies that the members have reached a consensus. They most certainly have not. Speaker Mike Johnson (R-LA) and other members of House Republican leadership are hoping that the proposal will cut enough money to please the budget hawks, but will do so in a manner that is enough under-the-radar to mollify the moderates. Johnson may well come up short on both counts. The hawks want much bigger cuts than the $600 billion or so that would be slashed if this proposal was to become law. And the moderates know that, by November 2026, those 8.6 million people will have noticed they don't have health insurance anymore, regardless of how covertly it is done.
Oh, and Johnson also hasn't figured out a middle way on the SALT issue, either. He's planning to try to tackle that today.
Undoubtedly, if a speaker is trying to move a budget, it's better to have something on paper than to have nothing. And maybe Johnson will be able to herd the cats. But from where we sit, it looks like the promised land is still far, far away. Like, 40 years of wandering in the desert far away.
And, as a postscript, allow us to note that The New York Times, in reporting on this story, had what struck us as one of the worst bothsidesism headlines we've ever seen. The story notes the CBO finding that 8.6 million people will lose their health insurance, but observes that House Minority Leader Hakeem Jeffries (D-NY) and other Democrats say it's going to be 13.7 million. And so, the headline is "Millions Would Lose Health Coverage Under G.O.P. Bill. But Not as Many as Democrats Say." Oh, those politicians! Some of them are trying to take away healthcare from millions of people, while others are exaggerating for political effect. They're all the same! (Z)