Opinion: The utter dishonesty about GOP’s Medicaid spending ‘cuts’

Wait a minute, don’t we support slowing down health-care costs? (Gabriella Demczuk / The New York Times)

It appears the Graham-Cassidy health bill is dead — for now — after Sen. Susan Collins of Maine on Monday became the third Republican to say she wouldn’t vote for it. In practical terms, this means (barring a reversal by either Sen. Rand Paul or Sen. John McCain, the previous “no” votes among a caucus of 52) health reform is delayed by at least a year, since doing it via the reconciliation process meant it had to be passed by Sept. 30 in order to fit into the fiscal 2018 budget. But fiscal 2019 is still a possibility, and senators ought to press forward with this bill as their starting point and go through the legislative process, if only to see if Collins and McCain are actually worried about procedure or just don’t want to change Obamacare.

In the meantime, Americans need to gain some understanding of just what a bill like this one does with respect to funding “cuts” for a program like Medicaid.

On the one hand, you have a widely circulated estimate by consultants at Avalere Health (with funding from the left-leaning Center for American Progress) saying Medicaid funding from 2020 to 2026 would be cut by a cumulative $215 billion*. On the other, you have this spreadsheet from the office of bill sponsor Sen. Lindsey Graham clearly showing Medicaid funding rises by a cumulative $230 billion during that time span. (Note that both estimates were for the bill as of last week; the bill was tweaked over the weekend.) What’s going on here?

What’s going on is the fundamentally dishonest way Washington talks about spending and spending “cuts.”

The spreadsheet from Graham’s office clearly shows that Medicaid spending would rise every year during the time frame, starting at $134.4 billion in 2020 and hitting $200 billion in 2026. The cumulative total, compared to that starting point of $134.4 billion, is $230 billion. Funding does not go down in a single year. In fact, the annual increases are 8.1 percent in 2021, 7.5 percent in 2022, 7.0 percent in 2023, 6.5 percent in 2024, 6.1 percent in 2025, and 5.8 percent in 2026. That’s right: The slowest rate of growth under these “cuts” is triple the rate of overall inflation in the U.S. right now.

So how does Avalere come up with a $215 billion funding decrease? By comparing Graham-Cassidy’s funding to the faster rate of increase under”current law.” Presumably, that’s why the analysis never shows actual funding amounts, just the “changes” — meaning, changes vs. today’s skyrocketing rates of increase. Otherwise, the implication that spending falls during this time period would be revealed for the falsehood it is.

Thus is an increase in funding — to the tune of a cumulative $230 billion, so that program would still receive a whopping 49 percent more in 2026 than in 2020 — branded as a “cut.”

Folks, if we can’t “cut” spending in this way, we may as well just throw in the towel as a nation.

Yet, this decrease-in-the-increase is how those in Washington, particularly Washington Democrats, routinely define a “cut.” Now consider the ramifications of adopting their definition: It means demagogues can portray anything less than the previously scheduled increase as some kind of cruel attack on America’s vulnerable, when in fact even at the end of this “cost-cutting” exercise from 2020 to 20206 funding would still rise on an annual basis by almost 6 percent.

I’m so old, I remember when “bending the cost curve (for health care) and starting to reduce costs for families, businesses, and government” (emphasis added) was something certain prominent Democrats supported.

I also remember — because it’s gone on all year — Democrats claiming credit for health-insurance premiums on HealthCare.gov rising by “only” 105 percent between 2013 and 2017 as a slowdown in costs, on the premise they might’ve grown more rapidly absent Obamacare.

So on the one hand, you have the GOP saying a “slowdown” to 105 percent growth over four years for health-insurance premiums is not good enough, and that funding increases of 8 percent or more for Medicaid are not sustainable.

At the same time, Democrats are saying the 105 percent increase on the exchange represents progress, and that increasing Medicaid funding by 6 percent instead of 8 percent represents devastation.

Which approach is the credible one?

It took political malpractice for Republicans, having seized the high ground when it comes to Obamacare, to let the left shape the narrative about health reform, first with the House’s bill, then with the Senate leadership’s bill, and now with Graham-Cassidy. Now that their own members are forcing them to slow down, perhaps they’ll figure out a better way to tell people what would actually happen under their proposals.

*The estimate goes on to say funding will drop by a further $3.9 trillion over the 10 years after that, because the bill doesn’t set out a funding rate beyond 2026. This requires people to believe Congress would basically eliminate Medicaid after 2026, which is fever-swamp stuff.

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306 comments
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breckenridge
breckenridge

"Roy Moore's election to the US Senate would be bad for America, and what's bad for America is not good for the Democratic party."  Howard Dean, former chairman of the DNC, 9-27-2017


Yes, there is a bit of smug chortling going on with some Dems.  But Howard Dean is correct; another far right (or far left ideologue) will simply make it harder to pass decent legislation.  Nor will it necessarily lead to more congressional seats for Dems.


Doomy:


1.  There is no way Roy Moore could win a republican primary for a US Senate seat in the state of Georgia.


2. In 2014 the 2nd most popular Google search in the state of Alabama was Is Obama the anti-Christ?  That would never happen in Georgia. So no, to try and paint Georgia and Alabama with the same whacko-bird brush just doesn't fly. 

 But is really surprising Moore won? He was elected to the state Supreme Court twice, and the second time it was already well known he was a total f-up.

MarkVV
MarkVV

Since Kyle has chosen (in his printed column today) to “illustrate” his argument with what I called below “feeble-minded analogies,” let’s illustrate how easy the choice of the words turns his argument upside down.He describes a man who adds 10 pounds of weight every year, then last year is only 5 pounds heavier.

Kyle asks: Did he a) gain weight, or “lose weight.”  But that is playing with words. One can just as well ask “Did he CUT his annual weight gain?”

MarkVV
MarkVV

Kyle is so obsessed with the word “cut” regarding Medicaid in the discussion n of the Graham/Cassidy (now thankfully lifeless) bill, that he has published his new version of his diatribe in the printed column of AJC. He, who complained in the past about nitpicking by others (namely me), is indulging in it again. And he is simply wrong, in spite of his feeble-minded “analogies.”

First, you might ask yourself: Would someone like Senator Susan Collins base her opposition to the bill in part on the issue of Medicaid, if it was not substantiating by reality? And all those medical organization?  But let’s examine the wording of Sen. Collins’ statement:

“First, both proposals make sweeping changes and cuts in the Medicaid program. Expert projections show that more than $1 trillion would be taken out of the Medicaid program between the years 2020 and 2036.”

Note the words: Sweeping changes and cuts. Plurals.  In Kyle’s words, “On its current path, Medicaid spending would grow even faster.” Even without being familiar with the details, what it means is that “on its current path” there were factors that resulted in a projected increase in Medicaid spending, and in the Graham/Cassidy plan those increases would be – CUT to lower levels. Therefore, “changes and cuts in the Medicaid program.”

Instead of spending time on arguing those factors  and whether Graham/Cassidy’s plan was more appropriate dealing with those, Kyle has indulged in attacking the word “cut.”

Bruno2
Bruno2

 Mark VV: " It is about the meaning of those words. If I say I am giving 10% to charity, and then reduce that percentage, I have made a cut in my charity giving, even if the total amount is higher."

Kyle--All I can tell you is that you have waaaay more patience than I have.

 

breckenridge
breckenridge

I suppose Roy Moore will ride into Washington on his horse and brandishing his six-shooter. He'll pull up in front of the Capitol building, empty his saddle bags full of Harry Potter novels, and start a big bonfire.  Because we don't want the kiddies reading about witchcraft, it's a form of persecuting Christians.

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vihowajoro

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breckenridge
breckenridge

@vihowajoro 

Oh wow.........$7455 in one month on the

That's just so very meaningful. Thanks for the heads up.

breckenridge
breckenridge

Trump is refusing to accept that Russian operatives, acting under direction (naturally) from Vladimir Putin, purchased Facebook ads in order to 1) affect the 2016 presidential election and 2)  more importantly, try to divide America.


I think this is a job for the CIA.  They should try to identify these Russian agents and, if successful, assassinate those that are accessible.  Send a clear, strong message to Moscow and that worthless piece of human garbage Putin that his meddling will answered in the harshest manner possible.

bu22
bu22

@breckenridge  Obama divided America more than Putin.  He meddled in many foreign elections, Israel's quite publically.  We already sent a clear strong message to Obama by electing Republicans in record numbers across the country.

Randy05
Randy05

Wow. How easy you jump to "assassinations". No trial now judge, just death...

SGTGrit
SGTGrit

The Democrat party infested with hard left ideologues will obstruct the Republican tax plan because they want to continue the Obama transformation of America into a lesser position in the world. The continuance of 2% GDP growth or less for the country is and has been their goal. Americans need to continue the fight to turn back this slime.

McGarnagle
McGarnagle

@SGTGrit


Yea. 2 % growth. Thats been the plan all along. Was that the Rush talking point today?

SGTGrit
SGTGrit

@McGarnagle @SGTGrit 

Don't know what Rush said. Nothing against him but I don't listen to Rush or watch Henniity. Sorry.

Starik
Starik

@SGTGrit @McGarnagle  Why do you think Trump wants to abolish the estate tax? Wouldn't it be nice to see Trump's tax returns?

SGTGrit
SGTGrit

@Starik @SGTGrit @McGarnagle 

I couldn't care less about Trump's tax returns. I care about tax policy and to answer your question about the estate/death tax it's an arcane policy that needs to be abolished.

Starik
Starik

@SGTGrit @Starik @McGarnagle Maybe. Still, when it's being pushed by somebody who will greatly benefit from it it needs to be carefully studied.

SGTGrit
SGTGrit

@Starik @SGTGrit @McGarnagle 

Maybe you don't know or understand this but Trump's children are already involved in his former business. In fact they run it. He wouldn't be subject to the death tax.

Starik
Starik

@SGTGrit  They're not accessible. And killing them would be ridiculous. Just low level FSB folk doing their job. 

breckenridge
breckenridge

@Starik @SGTGrit 


I disagree.  If a few of them are found stuffed in dumpsters, and riddled with bullet holes, it should cause the others to think seriously about whether the occupational risks make the job of trying to undermine the American political system a worthwhile endeavor.

Randy05
Randy05

Maybe because taxes have already been paid on the money it took to build the estate?

MarkVV
MarkVV

Doomy: “Pharmaceuticals are no different than any other profit seeking company. If you don't want to pay for their medications then don't buy them. 

That is all you need to know about the “humanity,’ or rather lack of it, of the author. 

Starik
Starik

@MarkVV  I do think he works in the insurance industry. 

breckenridge
breckenridge

@Starik @MarkVV 

You should be able to buy medication at the lowest possible price, regardless where in the world they are purchased, as long as it is from a reputable pharmacy. That is called a free market and competition.

McGarnagle
McGarnagle

@Hedley_Lammar


Price a goner. I think we'll hear Wingfield's take on the tax reform proposal put out by the white house. Its do or die for them. If they don't get this done, I refuse to listen to anything they list as an accomplishment. That supreme court pick is getting old.

Starik
Starik

@McGarnagle @Hedley_Lammar Let's have a look at Trump's tax returns and see how much he benefits. That goes for any Congressmen who vote in favor of it.

Hedley_Lammar
Hedley_Lammar

Where can we find liberal bastions California, New York, and Massachusetts? California is 43rd, getting back only $0.78 for every dollar it sends to Washington. New York is 42nd, and one penny better off, at $0.79 per dollar. Massachusetts is 40th, receiving $0.82 for every dollar it sends to DC.


The biggest question red states should be asking themselves is this


How much longer will rich blue states pay to keep them afloat ?

Doomy
Doomy

And so now, after 10 years of Obama running up nearly 10 trillion in debt, Hedley is all of a sudden a deficit hawk. Too funny!

Hedley_Lammar
Hedley_Lammar

@Doomy And after 8 years of complaining now all of a sudden it isnt a big deal


Even funnier.

Hedley_Lammar
Hedley_Lammar

 unlike many  states, have rung up 20 trillion in debt with their santa claus programs. 


Most of those benefits go to Red States. Mississippi being the worst offender.

Doomy
Doomy

@Hedley_Lammar


Those same red states that were poor and backwards for the first 150-200 years of being Democrat run states? Those states? LOL! Those same states that only became red within the last several decades? LOL! Those same states that have blue populations of 40-45% that suck up all those welfare benefits? LOL! 


One of the funniest things I've ever seen on this blog is to watch you try and make a cause and effect case using red states, which were long poor for the first 150-200 years of their existence under Dem rule, with Blue states- which largely became prosperous the first 150-200 years of their existence under Republican rule. 


Its nothing short of comical. 

Hedley_Lammar
Hedley_Lammar

@Doomy @Hedley_Lammar Those same red states that were poor and backwards for the first 150-200 years of being Democrat run states?


Yes those states


Governed by conservatives of both parties.


You know what is funnier ? You trying to pretend the Democrats of old in the South arent the Republicans of new.


Same bunch. They just switched parties after Democrats championed civil rights.


First to Dixiecrats. When Truman integrated the military.


Then eventually to the GOP.

TheCentrist
TheCentrist

One can play with one aspect of the bill but one thing we know for certain, less than 20% of Americans supported Graham-Cassidy.  Could anyone really imagine the heathcare insurance system being turned over to the legislators at the Gold Dome and it would be structured and operate effectively and efficiently?

Doomy
Doomy

@TheCentrist


" less than 20% of Americans supported Graham-Cassidy."


As if the rest of them know a darn thing about the bill. Geez. 


"Could anyone really imagine the heathcare insurance system being turned over to the legislators at the Gold Dome..."


Couldn't be any worse than turning over healthcare to the feds- the same feds who, unlike many  states, have rung up 20 trillion in debt with their santa claus programs. 

Hedley_Lammar
Hedley_Lammar

@Doomy @TheCentrist  As if the rest of them know a darn thing about the bill. Geez. 


How many hearings did they have to educate the public ?


A: Zero


So whose fault is that ?


BTW. The debt just crossed 20 trillion with Trump in office. And still going up. Wait till the tax cuts for Trump get here. 


Gonna explode.

Doomy
Doomy

@Hedley_Lammar @Doomy @TheCentrist


HAHAHAHAHA! Obama ran up nearly 10 trillion in debt and now you're complaining cause the debt, which was around 19.5 trillion when O left office, now hit 20 trillion? HAHAHAHAHAHAHAHAHAHAH!


You are hilarious beyond belief, Hedley!