To hear Democrats and the press corps tell it, Republican lawmakers took away healthcare from millions of poor and disabled people this summer. “People will die,” Democratic House Minority Leader Hakeem Jeffries said in May. “Trump’s Bill Slashes the Safety Net,” The New York Times wrote in June.
But push aside the rhetoric and look at the actual changes. The three key Medicaid reforms GOP lawmakers passed in July were modest: ensure able-bodied adults without children are working or volunteering part-time, take illegal immigrants off the benefit rolls, and check the eligibility of recipients more frequently.
As the program dives toward fiscal insolvency, these reasonable changes aimed to save Medicaid for the people it’s meant to help: poor, disabled, and truly vulnerable Americans. Opponents trotted out a scary number from the Congressional Budget Office: Republican Medicaid reforms would leave 7.6 million people without health coverage.
But of those 7.6 million, 4.8 million were able-bodied, prime-age, childless adults whom the CBO expected would refuse to work or at least volunteer 20 hours per week. Another 1.4 million were illegal migrants or others ineligible due to immigration status. About 1.6 million of the newly uninsured would be caught by other safety-net programs like Obamacare coverage.
Republicans could have gone further. They shrank from more substantive reforms to Obamacare expansion subsidies, federal reimbursement rates, and the “provider tax” spending loophole. That didn’t save them from the usual browbeating. In a floor speech after the bill passed the House, Jeffries still accused GOP lawmakers of “ripping healthcare away from the American people.”
There are lessons for Republicans here. For one, no matter how modest the reform, GOP lawmakers will incur the same political cost. This summer, they chose the worst of both worlds, taking the expected smearing but securing only modest reforms.
Most Republicans also did their best not to talk about Medicaid when it could have been a political winner. Did you ever hear about these reforms from Republicans? They could have pointed out that Democrats were in favor of illegal migrants and able-bodied, childless adults receiving Medicaid benefits. Instead, Republicans convinced themselves they were losing whenever they uttered the word “Medicaid” and ceded the debate to Democrats.
If work requirements are our new definition of cruelty, then every U.S. entitlement program is destined for insolvency. The growing national debt is an old story. Medicaid spending has grown by 60% since 2019 and will continue to grow even after the new changes. Welfare programs make up nearly two-thirds of federal spending every year, far outpacing defense, foreign aid, and any other type of expenditure.
It may take a catalyzing crisis to rally an apathetic majority to end this nose-dive toward fiscal bankruptcy. But someday, even in Washington, austerity will be in fashion.
