One of the most heartening moments at the Peterson Fiscal Summit was National Economic Council Director Gene Sperling’s effort to stand up for Medicaid. Hitting House Republicans for gutting Medicaid isn’t the kind of political bonanza that attacking their Medicare plan is, but by the same token it seems more politically realistic to worry that it might action happen. Not if Sperling has anything to do about it:
And I say this to everybody in this room, there is enormous discussion about the revenue side and the Medicare side. But from a policy perspective, from a values perspective, we should be very deeply troubled by the Medicaid cuts in the House Republican plan. I want to make clear what they are. This is not my numbers, this is theirs. After they completely repeal the Affordable Care act, which would take away coverage for 34 million Americans, according to the Congressional Budget Office. After they’ve completely repealed that, they do a block grant that would cut Medicaid by $770 billion. In 2021, that would cut the program by 35 percent. Under their own numbers, by 2030, it would cut projected spending in Medicaid by half. By 49 percent. So, of course — I don’t think — or imply any negative intentions or — lack of compassion. But there is a tyranny of the numbers that we have to face.
And here’s the tyranny of the numbers. Sixty-four percent of Medicaid spending goes to older people in nursing homes or families who have someone with serious disabilities. Another 22 percent goes to 35 million very poor children. Now I ask you, how could you possibly cut 35 percent of that budget and not hurt hundreds of thousands, if not millions of families who are dealing with a parent or a grandparent in a nursing home, or a child with serious disabilities. How is the math possible. If you tried to protect them mathematically, you would have to eliminate coverage for all 34 million children. Now I know some people didn’t like when — the President mentioned that this was going to be very negative for families, for those amazingly brave parents. And he may be one of them in our country, who have a child with autism or Down’s and who just are enormously committed and dedicated to doing everything they can to give their child the same chance — every other child has. But here’s the reality. Medicaid does help so many families in those situations. Over the years, we’ve allowed more middle class families who have a child with autism to get help in Medicaid. There’s a medical needy program that says when you spend down — we’ll — we’ll count the income after you’ve spent down medical costs. There’s a Katie Beckett (PH) program that was passed by President Reagan that says if you have a child that’s in need of institutional care — you can get help from Medicaid. This is — this is a life support for many of these families. But these are the optional programs in Medicaid. These are the ones that go to more middle class families. If you’re going to cut 49 percent of projected Medicaid spending by 2030, do you really think these programs will not be seriously hurt?
Well said. The conceit that somehow the magic of “flexibility” will let states absorb these cuts is absurd. The flexibility the House Republicans are talking about is the flexibility to stop covering people in need. That does save money, and that does allow for lower taxes, and there’s a case to be made that lower taxes are more important than health care for autistic children. But we should debate the real issue here and not pretend that it’s about flexibility.