Jonathan Cohn in the Bulwark lays out the Republican moral deservingness language that will justify large cuts to Medicaid Expansion:
THE LIKELIHOOD OF DONALD TRUMP and his allies in Congress taking Medicaid away from millions of low-income Americans—and, in the process, rolling back a huge piece of the Affordable Care Act—has increased significantly in the last two weeks…
But the interest in ending expansion funding is still there—in no small part because the money is still there—and in recent years especially Republicans have spun their efforts more as an attempt to preserve Medicaid for what they say are the truly vulnerable groups that need it.
One source for this argument is the Paragon Health Institute, one of several think tanks launched by alumni of the first Trump administration, whose researchers have argued that adding all of these working-age, childless adults to Medicaid has put extra financial strains on the program, while overwhelming the doctors and other providers who see Medicaid patients. As a result, these researchers say, the children, pregnant women, seniors, and people with disabilities who had previously depended on the program now have a harder time getting care.
Medicaid Expansion has the federal government pay 90% of the costs while Legacy Medicaid has the Feds cover between 50% and 77% of costs as a function of a state’s per capita income. The argument is that the extra federal funds push states to focus on the Expansion population and away from the Legacy population. There is a big component of deservingness thinking. American social welfare policy mostly comes out of the Victorian work paradigm where public help is only available to the “deserving” identities including the disabled, the widowed, the blind, the pregnant and perhaps some kids. Anyone else would be expected to go to the work house or the colonies. Legacy Medicaid is mostly about the “deserving poor”. Medicaid Expansion helps the working poor, who mostly don’t have one of these deserving identities.
That is the pitch that Johnson is making right now.
It is also a pitch to wreck rural hospitals, but that is a discussion for another week.
Exciting New Effort, With An Eye Toward the PA Supreme Court Retention Election In November
Professor Bigfoot
The Davis X.Machina Dictum always applies.
suzanne
My heart is heavy for those who voted for Harris who get hurt by this.
Old Man Shadow
“The only good welfare is mine.” – Republicans
Rugosa
How are the working poor not deserving? This is typical Republican BS. One day they’re screaming about work requirements to get health care, the next they’re pitting the working poor against the supposedly deserving. But they don’t support care for the supposedly deserving, either. Real hall-of-mirrors stuff.
Jeffro
They will go ahead and do it anyway, and blame LIBRULZ!!1!! for it, and their idiot base will believe them. We can’t just wait for it to happen and then go, “well, that was the GOP who did that”.
A presser at a rural hospital, NOW, would be a good idea for Dem elected officials.
Butch
I don’t think many observers agree with Cohn. This is from The Hill:
The most ambitious plan floated so far, to reduce Medicaid spending by hundreds of billions of dollars, now appears all but dead after a dozen House Republicans informed their leadership this week that they would not support a bill that includes any reduction in Medicaid coverage to vulnerable populations.
https://thehill.com/homenews/senate/5255483-trump-agenda-funding-problems/
Chief Oshkosh
There two huge differences between every other developed country and the US:
There are guns everywhere in the US, with lots and lots of gun crime with deaths of innocents.
There is broad and accessible (if not universal) healthcare everywhere but in the US.
Both are due nearly entirely to the Republican Party. They are proud of it. We and the rest of the world look on in horror.
JML
@Rugosa: It’s very GOP thinking. they want us to get into an argument about who is and who isn’t deserving, because then they can lie like the disgusting a$$holes they are and pretend that immigrants, non-whites, and anyone they think is disfavored are “stealing” from the “deserving”.
Evil bastards, the lot of them. Selfish and evil.
Another Scott
@Butch: That piece is full of stuff like:
The Tantrum Caucuses want what they want.
Of course, they all know that this is their only chance to destroy everything, so they’re going to keep trying.
Magic beans may be on the menu…
Thanks.
Best wishes,
Scott.
kindness
Medicaid pays for SNF and assisted care facility stays after Ma/Pa/Grandma/Grandpa had a hospital event that requires an admit to an SNF/Assisted Care following discharge from the hospital.
Won’t these families be overjoyed to learn they are now on the hook for $5 – $10K a day for their loved one?
rikyrah
Once again…
the largest percentage of Medicaid Dollars is spent on GRANDMA AND GRANDPA’S NURSING HOME BILL.
Ohio Mom
Who provides support services such as personal care to disabled people? The working poor, anybody who works in the field is automatically poor, the pay is so low.
So you could spare disabled people from Medicaid cuts but if you take away Medicaid Expansion, you are still hurting disabled people because they need hale, hearty and healthy support staff. (Actually, some days they just need barely functioning support staff, there is such a shortage of workers).
rikyrah
THE.WORKING.POOR
THE.WORKING.POOR
THE.WORKING.POOR
These people WORK
Steve LaBonne
@Another Scott: You do it with big cuts to our bloated military establishment. But as always these sickos actually want to shovel even more money into that maw.
Ohio Mom
@rikyrah: And running a close second is disabled people.
Steve LaBonne
@rikyrah: That makes them dumb. Billionaires who neither work nor pay taxes are smart.
David Anderson
@Butch: I trust Cohn over the Hill
rikyrah
@David Anderson:
Someone had done an analysis of their districts. Except for 1, all of them were in R+ ( 1-5) districts
robtrim
Private hospitals, rural and non rural, are in danger from the vultures of private equity. The Washington Post and NY Times have written about these pump and dump schemes recently. PE buys the hospital with promises of improved care. They then reduce care and services while paying themselves and insiders bigger bucks. They also lease back the land the hospital sits on, which increases the hospital debt and gives the proceeds to the PE entity. Eventually, when they have milked the hospital for PE profits they declare bankruptcy and leave. And who is going to buy a bankrupt hospital?
How to make people sicker: https://hms.harvard.edu/news/what-happens-when-private-equity-takes-over-hospital
HopefullyNotcassandra
@suzanne: My heart is heavy for everybody who will be hurt by this.
This will return vast swathes of our country to the medical plan of don’t get sick and if you do, die quickly. Some of those hurt may be major maga, but their babies are still babies.
HopefullyNotcassandra
@Butch: Actually, the GOP’ers in your link are agreeing with Cohn.
They want no cuts to “vulnerable population” and everyone else on Medicaid, is SOL.
All so the GOP can give ICE billions to increase their jack booted thugs act and tax breaks for billionaires. It is pure dystopia.
HopefullyNotcassandra
@Another Scott: Watch our treasury markets. I fear this latest gop fiscal insanity inanity will make those markets “yippie”-er.
gene108
I wonder what billionaire fuck face threw this think tank together to churn out the “facts” Johnson is using to dismantle Medicaid and the ACA?
As long as hacks exist to churn out “evidence” for anyone willing to pay, I think we will be fighting a never ending battle of right-wing propaganda and disinformation.
Also, around 20 years ago, I had a friend on Medicaid and either SSI or SSDI. She was getting better and wanted to work. If she worked, she’d lose Medicaid and access to treatment that put her in a position to work again.
First time I’d known someone on government assistance. I found the amount a person could earn without losing benefits to be ridiculously low. Part-time at Wendy’s would cause a loss of benefits. It disincentivized people from getting off of assistance.
Medicaid expansion not only filled a hole for the working poor, but also gave people wanting to get off assistance and work a path to doing it, without losing their healthcare.
Since Republicans are hypocrites of the worst sort, I’m not surprised they want to force the “deserving” people to choose between healthcare and work.
suzanne
@HopefullyNotcassandra: I always feel terrible for the kids of GOP voters. But I’m fresh out of give-a-damn for GOP voters themselves.
HopefullyNotcassandra
@Steve LaBonne: You do it by having a sane progressive tax policy, one in which a secretary does not pay a higher tax rate than a billionaire. There is no chance of that with these silly persons.
Steve in the ATL
@HopefullyNotcassandra: they don’t care whatsoever about vulnerable populations. That’s just code for “my voters”.
gene108
@Chief Oshkosh:
Crime in the U.S. is not terribly high. Getting people riled up about non-existent crime waves is one path Republicans take to win elections.
We have a problem with mass shootings, which no other country has.
The gun industry has created a market where too many people believe guns everywhere is an inalienable right, when it has historically never been until the 21st century.
Approximately 92% of the U.S. population has health insurance. If non-Medicaid expansion states weren’t revanchist assholes about healthcare coverage, we could be very very close to universal coverage.
Making medical care affordable is a different issue to tackle.
JML
@robtrim: and rural hospitals are so desperate for any kind of financial support, they’ll still grab on to the PE vultures like a lifeline. not caring that it will only hasten the end.
Unfortunately, there’s way too many rural whites that have the blinders on and would prefer to buy the lie than see the truth. hate is a powerful drug.
Steve LaBonne
@HopefullyNotcassandra: That too, obviously very much so, but once you decide to cut spending, defense and what is left of the safety net are literally the only places that are more than a rounding error in the budget.
Ohio Mom
@robtrim: Same thing private equity does to retail (JoAnn Fabrics is the latest causality) and restaurants (Red Lobster, Cincinnati’s Big Boy chain, etc).
It’s a very flexible formula that private equity has developed. They need to be regulated out of existence, that won’t happen in this timeline though.
Gretchen
A lot of rural hospitals are already gone in non-expansion states. That’s one reason maternal mortality has gone up in Southern states. When someone in trouble has to drive 2 hours to get to the hospital, they’ll be in more trouble when they get there.
Dr. Oz’s brilliant idea for healthcare is to have 15 minutes in a « festival-like atmosphere » – like those fairgrounds clinics that shocked the conscience back in the 2000s and helped pass the ACA.
gene108
@robtrim:
This has been a standard PE mergers and acquisition strategy since the 1980’s. Buy a business, promise great things, and then strip for parts to pay investors back.
Probably one of the biggest reasons so much manufacturing moved overseas, that goes unreported, is because companies not trying to squeeze every penny out of every worker are prime targets for PE investors.
The movie Wall Street is a depiction of what was a new breed of investors in the 1980’s.
Ohio Mom
@gene108: You could lose SSI or SSDI benefits by earning too much but each program has a different way of calculating when you fall off the cliff.
For SSI, you can not have more than $2,000 in assets but there is no cap for SSDI. There are a lot of arcane rules to both programs.
Eunicecycle
@robtrim: I was just reading about a hospital system in PA closing for just this reason:Private equity.
RevRick
@Rugosa: Republican ideology is based in a certain penitential theology, where the “saved” go to heaven and the “damned” to Hell. It shares something with the Indian system of caste, where your lot in life is set by how good or bad you were in a prior existence.
According to the secular version of this belief system, it is monumentally unfair to those who work hard for them to have to pay taxes to support programs for the lazy and shiftless poor, for those who have made bad life choices.
Of course, there is a huge element of disingenuousness in this, because the idle rich get a pass.
Underlying all this is the assumption that people are fundamentally bad and will look for every opportunity to cheat. (Perhaps this is some of the appeal of Trump for them since he confirms all their suspicions). So, the only thing that keeps people on the straight and narrow, they believe, is the threat of punishment. Generosity gets seen as foolishness. Grace can only ever be earned (which is singularly graceless).
Power and wealth are seen as signs of God’s favor, poverty carries more than a whiff of God’s condemnation.
Matt McIrvin
@gene108: There’s a death spiral they want to get going:
Repeat until it’s gone.
Ruckus
@Steve LaBonne:
A lot has changed in the over 1/2 a century since I was discharged from the USN but I will say that believing that we spend too much on national security military wise so we should massively cut their budget, I’m not sure is actually a good deal or accurate.
Now I’m not saying that we don’t spend a lot or quite possibly too much, but rational, reasonable defense equipment is expensive and if pay in the military is anything like it was a long time ago we really should look at the big picture before we decide to cut it massively. You can think that we likely won’t get into another war, but there are likely those in other countries that seeing shit for brains and how he only reacts, and doesn’t actually think at all may not agree with you.
My point is that you don’t stop wars by reacting to one you didn’t expect, you have to be ready for one that might never happen, which lessens the likelihood of one actually happening.
And I hope that we never have another but wishful thinking doesn’t always get the job done.
Ruckus
@gene108:
Since Republicans are hypocrites of the worst sort, I’m not surprised they want to force the “deserving” people to choose between healthcare and work.
I wonder how many of the wealthy didn’t actually earn their money, at least most of it, and of course they didn’t earn it by common physical work, but it was very likely left to them by someone. shitforbrains is in that category. His father owned a lot of rental property and made a substantial income from it. shitforbrains has gone bankrupt 4 times. So successful – not so much.
sab
@kindness: SNF: Saturday Night Fever, or Skilled Nursing Facility.
sab
@David Anderson: Me too. Wasn’t Cohn one of the guys who actually read and i intelligently discussed the ACA back before it passed?
sab
@robtrim: My city’s second biggest hospital chain just did that. They had to go for profit to pull it off, and most of the you ger doctors left because they need to work for a non-profit to get their med school debt forgiven.
Ruckus
@gene108:
I owned a manufacturing company that my dad started, we made specialty tools for others to make things they sold and containers to put products in – plastic bottles from 4 oz to 5 gal and other plastic products. Some of our wage costs were from the general economy – what it took to hire professional, technical people to do the work. A lot of the movement overseas was due to labor costs which raised the cost of the products/tools we made. And even in a major populated area finding enough employees with the skills necessary, which didn’t help the employment costs. Now I’ve been out of that business for a while so I have zero idea about it today – but I do know that it didn’t get cheaper. And other countries, like China, can do this work cheaper, possibly not a lot cheaper but there are more customers today than 30 yrs ago so the cost has likely risen a lot here in the US, and less so in places like China. GM just closed a factory. I’d bet they didn’t do this on a whim but likely with a lot of forethought.
Gvg
@Ruckus: It is possible there are inefficiencies due to the need to parcel out the contracts to as many congressional districts as possible, but I agree. I suspect we aren’t really overspending that much. We have elected fools for leaders that make us look much more attackable and Trump is actively sabotaging our sane military’s attempts to plan for a good defense, not to mention losing allies which weakens us. Oh, and throwing away the power of diplomacy by not abiding by prior treaties, and then trying to sabotage the power of the dollar both of which have military and cost implications.
We wasted money in stupid wars like Afghanistan (run so badly it was hopeless) and Iraq (never should have happened). Does that count? Trump revealing we could turn off our equipment remotely because his feeling were hurt tanked the value of a lot of our equipment that we paid for the development of over years (taxpayer money) which makes that a wasted investment, but we didn’t know that when we spent the money.
i don’t think those are what the Republican voters mean though. Mostly their kind of waste and fraud just isn’t there.
Ruckus
@Gvg:
Yep. We actually have a fairly robust government. Not now of course because of the top of the pile consists of BS, lies, a lot more BS and possibly a current IQ of unmeasurable smallness.
jefft452
“It is also a pitch to wreck rural hospitals, but that is a discussion for another week.”
They can make do with a mustard seed poultice and be allowed to donate to the faith healer of their choice
BritinChicago
@Ruckus: Yes. I’m sure there’s a huge amount of waste in the defense budget (a lot of it driven by Congress), but it was a lot easier to be in favor of big defense cuts before Putin invaded Ukraine in 2014, or before people here took notice of it with his reinvasion in 2022.