The budget wars are just getting underway, and Republicans are targeting Medicaid for hundreds of millions of dollars in cuts.
The House Energy and Commerce Committee has been asked to come up with $880 billion in savings over 10 years as part of the budget deal approved by the Budget Committee. It's a big ask. The only way to get that kind of savings is by finding ways to cut Medicaid, which provides subsidized benefits to millions of Americans, including children and old people.
No one doubts that the Medicaid program has tens of billions of dollars in waste, fraud, and abuse. Millionaires enrolled in Medicaid, fraudsters absconding with up to $100 million in Medicaid funds, and individuals routinely sent to prison for one fraudulent Medicaid scheme or another show that the fraud is there. Finding it is another matter.
Everyone also knows that the Medicaid fraudsters who are convicted represent a fraction of the total number of criminals engaged in cheating the American taxpayer through Medicaid billing schemes.
“If you eliminate fraud, waste, and abuse in Medicaid, you’ve got a huge amount of money that you can spend on real priorities for the country,” House Speaker Mike Johnson (R-La.) told reporters during a press conference last week.
Weeding out the fraud and waste is a time-consuming, painstaking task. The Energy and Commerce Committee doesn't have the time or the manpower to find hundreds of billions of dollars in misused Medicaid funds. The savings are going to have to come from somewhere else.
Medicaid was massively expanded with the advent of Obamacare, as most states have now taken the deal that the federal government will pay for most of that expansion, covering adults who make 138% of the federal poverty level ($21,600). Many states have made the cutoff even more generous.
The expansion of Medicaid will be the GOP's number one target as it tries to bring the program back to its pre-Obamacare status. This means that millions of voters are going to lose their Medicaid benefits. Republicans will also try to add some kind of work requirement for some Medicaid recipients
“And if you make sure that people who are able-bodied workers — you know men under the age of 40 for example, who have rolled on to Medicaid and gotten onto the expansion and need to be working — … it makes sense to people," said Johnson.
Democrats are licking their chops.
“Republicans’ budget proposal is a betrayal of American families — slashing Medicaid, Medicare, & Social Security to finance $4.5 trillion in tax breaks for billionaires,” Rep. Paul Tonko (D-N.Y.) said. “Budgets reflect values — and theirs puts working people last.”
No one is talking about "slashing" Medicare or Social Security. That's a typical scare tactic by Democrats. Next, they'll be telling seniors that the GOP wants you to eat dog food.
“Their objective, actually, is to pass massive tax cuts for billionaires, donors, and their wealthy corporations. And then … stick working-class Americans with the bill by slashing and burning things like Medicaid to the ground,” House Minority Leader Hakeem Jeffries (D-N.Y.) recently told MSNBC.
It's a little more complicated than that, but it makes for a good sound bite.
Not all Republicans are on board with cuts to Medicaid. Members in competitive districts can already see the Democrats' campaign attack ads.
The prospect of Medicaid cuts is getting plenty of pushback from some moderate Republicans, especially those with large Medicaid populations in their districts. Those voices are already sending warning signals that GOP leaders will have to prove that their plan cuts the $880 billion without slashing program benefits — or the bill will never reach Trump’s desk.
“If the inference is there’s no path to 880 without drastically hurting poor people, then the bill is dead — then the bill won’t work, because scores of Republicans will vote against it and the president will blast it,” one centrist House Republican said. “So now is the time for the committees to do their work and then subsequently show it to members to figure out how to get to 880 without crushing poor people.”
Democratic campaign operatives are hoping to exploit those GOP anxieties.
Medicaid was supposed to be a program for the poorest of the poor. It was never meant to be a middle-class backstop for health insurance. If Republicans can return the program to some of its original intent, they will probably find enough savings while leaving most of the program intact.
