Three-card monte on Capitol Hill
The Republican-controlled House of Representatives passed Donald Trump’s budget bill (you know what he calls it) by a single vote early Thursday (The New York Times):
The House early Thursday narrowly passed a wide-ranging bill to deliver President Trump’s domestic agenda, after Speaker Mike Johnson put down several mini-rebellions in Republican ranks to muscle the legislation to its first major victory over unified Democratic opposition.
The early morning vote was 215 to 214, mostly along party lines. The legislation would slash taxes, steer more money to the military and border security, and pay for some of this with cuts to Medicaid, food assistance, education and clean energy programs, adding significantly to federal deficits and to the ranks of the uninsured.
Lee Papa notes, rudely, that Democrats’ age problem contributed to the bill’s passage, but that’s another story:
When is a budget cut not a cut? When it’s a reform, of course. Republican chair of the House Ways and Means Committee, Jason Smith, quickly corrected himself on Fox News when he first let “cuts” slide from his lips. Even Republican voters oppose cuts.
Donald Trump is giving tax breaks to his rich friends while you pay more at Walmart and lose Medicaid and Medicare coverage. The trick is to disguise the cuts, argue Pamela Herd and Don Moynihan in their op-ed:
To control the political damage, Republicans are pursuing a strategy to reduce benefits, while pretending otherwise. They’ve mostly abandoned transparent cuts, such as eligibility changes or spending reductions to states, because it’s easy for voters to understand that damage. Instead, Republicans are opting for opaque cuts, which will shed millions of eligible beneficiaries by overwhelming them with pointless paperwork and other needlessly complicated administrative requirements.
Over the past 15 years, Herd and Moynihan argue, real Medicaid reforms have made it easier for Americans in need to access the health care, including “simplifying applications, eliminating confusing paperwork and automating processes, especially when it comes to renewing benefits.” You know, efficiency, that sprite Elon Musk’s DOGEes claim to want more of.
This resulted in more Medicaid beneficiaries, more spending, and more happier Americans with health insurance. Naturally, our overlords had to put a stop to that.
Hoops, hurdles, and false economy
Adding work requirements to Medicaid access has drawn a lot of attention. (Herd and Moynihan flesh out more of that element this morning at Can We Still Govern? And, no, work requirements don’t “work.”) Republicans don’t have to drown government in the bathtub when they can drown popular programs in red tape.
Digging deeper into the bill, the pattern of using burdens to quietly kick off eligible beneficiaries becomes undeniable. The bill would pause a series of comprehensive new rules, issued by the Biden administration, to make it easier for people to navigate Medicaid’s eligibility and renewal processes. The mixture of reforms would have ensured that millions of people who were eligible for benefits, including disabled people, actually received them.
The Republicans’ bill would also require more beneficiaries to renew their coverage twice a year. Since the passage of Obamacare, most people have had to repeat this process only annually. Not only would the twice-a-year requirement cost people a lot of additional time and effort, many eligible people would lose coverage during this process. By some estimates, one-third of people who lose Medicaid quickly regain it, signaling they lost it because of procedural mistakes rather than becoming ineligible. That is why recent reforms have lengthened periods between renewals.
Another new burden would require beneficiaries to pay when they go to the doctor. Co-pays reduce health care use, but do not produce cost savings. One study found that even a $12.50 co-pay discouraged women from getting a mammogram. Moreover, there’s evidence that some of the people needing health care the most are among the most likely not to get it.
There’s more, of course. Gotta reduce waste, fraud, and abuce, dontcha know. But that’s just Medicaid. The structure, if not the language, of the bill will force cuts to Medicare without mandating them. Hiding the cuts with sleight-of-legislation is the Capitol Hill version of three-car monte.
“Medicaid, you gotta be careful,” Steve Bannon warned in February. “Because a lot of MAGAs are on Medicaid, I’m telling you. If you don’t think so, you are dead wrong.”
On Tuesday, the Congressional Budget Office (CBO) estimated that Trump’s bill will add $2.3 trillion to the debt over 10 years. Jacob Bogage and Abha Bhattarai explain what that means in The Washington Post:
When legislation significantly adds to the national debt, which already exceeds $36.2 trillion, it triggers “sequestration,” or compulsory budgetary reductions. In that scenario, Medicare cuts would be capped at 4 percent annually, or $490 billion over 10 years, the CBO reported in response to a request from Rep. Brendan Boyle (Pennsylvania), the top Democrat on the Budget Committee.
“Sequestration isn’t a given,” Nathaniel Weixel instructs at The Hill. “Congress can ignore the rules requiring mandatory offsets or pass legislation later that will cut the deficit.” But when Medicare cuts arrive seemingly out of thin air, they will sting.
But neither Medicaid or Medicare cuts will sting America’s richest.
* * * * *
Have you fought dictatorship today?
No Kings Day, June 14th
The Resistance Lab
Choose Democracy
Indivisible: A Guide to Democracy on the Brink
You Have Power
Chop Wood, Carry Water
Thirty lonely but beautiful actions
Attending a Protest Surveillance Self-Defense