Kindly Republican "Moderates" Only Want To Gut Medicaid By Half A Trillion Dollars, Not $880 Billion

"RFK Jr is cured" by Greg Bart

If all the Republicans in the House were heartless neo-fascists— or if enough of them were— they wouldn’t have to worry about a handful of vaguely mainstream conservatives who feel badly about taking away healthcare from tens of millions of Americans. But the extremists are insisting on chopping over $880 billion from Medicaid and the small— but needed— less extreme faction say they’ll only go as far as half a trillion. Yesterday, as the Republicans were trying to craft their final bill, Omaha’s Don Bacon was reported to have drawn a red line in the sand— no more than $500 billion, which will just kill far less people than $880 billion. “Bacon has conveyed he wants to limit the changes to Medicaid to implementing the first-ever federal work requirements for the program, excluding noncitizens from eligibility for benefits and mandating more frequent eligibility checks… [So called] moderates are wary of changes that could cut deep into safety-net programs, while [neo-fascist] hard-liners want to drastically slash them— all with slim margins in the House and Senate. Bacon’s vote could be crucial, and other lawmakers share his concerns about Medicaid cuts. If all members currently sworn are present and voting, Speaker Mike Johnson can lose no more than three Republicans on a party-line vote. Two GOP members, Thomas Massie of Kentucky and Victoria Spartz of Indiana, voted against a budget blueprint for the bill earlier this month.”

According the Hill reporters Meredith Hill and Ben Leonard, at the GOP closed door meeting Monday night, basically to discuss how to steal the funds from the public without anyone knowing it’s being stolen, “lawmakers discussed at length a new version of a plan to place so-called ‘per capita caps’ on Medicaid funding to certain beneficiaries in states that have expanded the program under the Affordable Care Act” (all states but a small handful of the most backward right-wing states ruled by primitives).

The emerging plan would still risk Medicaid health care services for millions of low-income people by shifting the costs of any additional coverage beyond the federal allotment to states as Republicans hunt for savings to pay for the party-line package to enact Trump’s agenda. The expansion program that many GOP-led states have embraced has helped contribute to record-low rates of uninsured people.

…Capping federal Medicaid payments to states that have expanded the program is among the most controversial ideas that Republicans have discussed, since it could lead to massive coverage losses. But it is a preferable among many lawmakers to another proposal that would reduce the federal share of payments into the joint state-federal program in the 41 Medicaid expansion states.

Scaling down the federal percentage would invoke so-called trigger laws in some of those states, leading to major coverage losses. Per capita caps, on the other hand, would not create that problem, lawmakers believe.

GOP members across the Virginia delegation and a handful of Medicaid expansion states with trigger laws have privately warned their leadership that there is not sufficient support within the conference for proposals that would reduce the federal government’s share of Medicaid costs, according to two Republicans granted anonymity to share private conversations.

Sahil Kapur reported that right-wing freak Brett Guthrie (R-KY) the chair of the House Energy and Commerce Committee, had come up with the bullshit excuse they can use to try to sell their horrible plan to the voters:

“We have an expansion population that gets 90% federal money, and you have traditional [Medicaid], so a disabled child in Kentucky gets 72 cents when they go to the doctor. And we know that’s just unsustainable. We want to fix that so everybody gets coverage. So I think it’s going to be a really responsible response.”

“The ACA took a three-pronged approach to increasing access to health coverage— Medicaid expansion, tax credits to make premiums more affordable for those who lack employer-provided insurance and pre-existing condition protections. The Medicaid expansion has been a key part of reducing the uninsured rate to the lowest levels in history,” said Larry Levitt, executive vice president for health policy at KFF, a research group.

Levitt called the 90% federal promise “key to getting both red and blue states to take” the Medicaid expansion after the Supreme Court made it optional. Lowering it to the traditional rate the feds pay on Medicaid “would be a huge cost shift to states, and many would have difficulty coming up with the extra money,” he added. “Some states even have triggers that would eliminate the expansion if the match rate is lowered.”

Medicaid funding has emerged as one the biggest policy issues Republicans are trying to work through as they craft their party-line bill for Trump's agenda, which includes extending his 2017 tax cuts, boosting funding for immigration enforcement and the military and raising the debt limit.

Speaker Mike Johnson (R-LA) has laid out an ambitious timeline of passing the bill through the House by Memorial Day. And Treasury Secretary Scott Bessent said Monday he hoped the bill would arrive at Trump's desk by July 4.

Guthrie told NBC News he’s working on finding consensus, given the House GOP’s narrow majority and no hope of winning Democratic support for the package.

“People say: ‘This is my red line. I can’t cross it.’ And we say, ‘OK, where can we meet?’ And that’s what we’re working,” he said.

Rep. Austin Scott (R-GA) endorsed the potential Medicaid change.

“When the Dems expanded Medicaid under the Affordable Care Act, they made that percentage match 90-10%. So the federal government is paying 90% of the Medicaid expansion. So what we have talked about is moving that 90% level of the expansion back towards the more traditional levels of 50% to approximately 80%, instead of the 90-10— 90% being federal, 10% being state— match,” Scott said last week on Fox News.

“And nobody would be kicked off Medicaid as long as the governors decided that they want to continue to fund the program. And so we are going to ask the states to pick up and pay some additional percentage of Medicaid,” he continued.

Some lawmakers cast doubt on the proposal.

“That’s easy to say. States can’t print money the way they can around here. So it would be very difficult for the state to make up that difference,” said Sen. Angus King (I-ME). “It would be very harmful to people. One of the things that people don’t realize is 70% of the nursing home folks in Maine are on Medicaid... So that kind of cut would be a burden on the state that’d be very hard to meet.”

Plenty of Republicans have voiced reservations about significant Medicaid cuts, and their votes could make or break the bill’s prospects. Even Trump has promised that reductions in Medicaid funding wouldn’t harm benefits.

Sen. Lisa Murkowski (R-AK) said she’s skeptical of unwinding the funding passed under the ACA.

“I’ve supported not only the ACA premium subsidies, but Alaska has really seen the direct benefit of Medicaid expansion,” Murkowski said Monday. “The premium supports have been very important to my state. And the fear amongst many, many is that those go away and people will not be able to afford their health care.

“They’re still going to have challenges. They’re still going to need care. They’re going to end up in the emergency room,” she added. “So these are some of the things that Alaskans have been sharing with me.”

Sen. Susan Collins (R-ME) said she hasn’t seen the specifics of the Medicaid policy.

“The one thing that I would support are carefully crafted work requirements for able-bodied adults without preschool children,” she told reporters. “But I want to make sure that we are not depriving seniors, children, low-income families, people with disabilities and our rural hospitals of Medicaid.”

Rep. Mike Lawler (R-NY) said last week on Fox Business that he’s open to work requirements for able-bodied adults, citizenship verification for Medicaid and more frequent eligibility checks.

“Beyond that, I am not going to consider any changes to cut benefits to anyone. Period,” said Lawler.

It’s important to remember that what the moron media calls “moderates” are to the right of Ronald Reagan on almost every issue. They are hard core conservatives but not necessarily open Trump worshippers or fascists. This morning a quartet of PunchBowlers reported that Guthrie is meeting with a gaggle of them to try to talk them into his latest scheme. None of them are moderates; but all of them, like Jefferson Van Drew (R-NJ), Young Kim (R-CA), Nicole Malliotakis (R-NY), David Valadao (R-CA), Don Bacon (R-NE), represent swingy districts where slashing Medicaid is unpopular and would jeopardize their reelection efforts next year. Valadao isn’t happy with fellow fake-moderate Don Bacon’s willingness to cut half trillion dollars from Medicaid. “I still think $500 billion is a lot, depending on how they score things [adding the cost estimate] might be all foo-foo numbers just to make people happy.” Yeah, I’ll bake a cake! You have any reefers? We can listen to songs like this and this, even this all night

Van Drew— who in the end will always vote any way Trump demands— roared that “We’re going to hold their feet to the fire to make sure there isn’t a lasting change. Attitude is what matters most here. We’re not just going to roll.” Attitude is not what matters most and they are going to roll.