By Robert
Reich
Bad enough that the Republican Senate bill would repeal much of
the Affordable Care Act.
Even
worse, it unravels the Medicaid Act of 1965 – which, even before
Obamacare, provided health insurance to millions of poor households and
elderly.
It’s
done with a sleight-of-hand intended to elude not only the public but also the
Congressional Budget Office.
Here’s
how the Senate Republican bill does it. The bill sets a per-person cap on
Medicaid spending in each state.
That cap looks innocent enough because it rises every year with inflation.
That cap looks innocent enough because it rises every year with inflation.
But
there’s a catch. Starting 8 years from now, in 2025, the Senate bill switches
its measure of inflation – from how rapidly medical costs are rising, to how
rapidly overall costs in the economy are rising.
Yet
medical costs are rising faster than overall costs. They’ll almost
surely continue to do so – as America’s elderly population grows, and
as new medical devices, technologies, and drugs prolong life.
Which means that after 2025, Medicaid will cover less and less of the costs of health care for the poor and elderly.
Over
time, that gap becomes huge. The nonpartisan Urban Institute estimates that just between 2025 and 2035, about
$467 billion less will be spent on Medicaid than would be spent than if
Medicaid funding were to keep up with the expected rise in medical costs.
So
millions of Americans will lose the Medicaid coverage they would have received
under the 1965 Medicaid act. Over the long term, Medicaid will unravel.
Will
anyone in future years know Medicaid’s unraveling began with this Senate
Republican bill ostensibly designed to repeal and replace the Affordable Care
Act? Probably not. The unraveling will occur gradually.
Will
future voters hold Republicans responsible? Again, unlikely. The effects of the
unraveling won’t become noticeable until most current Republican senators
are long past reelection.
Does
anyone now know this time bomb is buried in this bill?
It
doesn’t seem so. McConnell won’t even hold hearings on it.
Next
week the Congressional Budget Office will publish its analysis of the
bill. CBO reports on major bills like this are widely disseminated in the
media.
The CBO’s belated conclusion that the House’s bill to repeal and
replace the Affordable Care Act would cause 23 million Americans to lose their
health care prompted even Donald Trump to call it “mean, mean, mean.”
But
because the CBO’s estimates of the consequences of bills are typically limited
to 10 years (in this case, 2018 to 2028), the CBO’s analysis of the Senate
Republican bill will dramatically underestimate how many people will be
knocked off Medicaid over the long term.
Which
is exactly what Mitch McConnell has planned. This way, the public won’t be
tipped off to the Medicaid unraveling hidden inside the bill.
For
years, Republicans have been looking for ways to undermine America’s three core
social insurance programs – Medicaid, Medicare, and Social Security.
The three constitute the major legacies of the Democrats,
of Franklin D. Roosevelt and Lyndon Johnson. All continue to be immensely
popular.
Now,
McConnell and his Senate Republican colleagues think they’ve found a way to
unravel Medicaid without anyone noticing.
Don’t
be fooled. Spread the word.
ROBERT B. REICH is Chancellor's Professor of Public Policy at
the University of California at Berkeley and Senior Fellow at the Blum Center
for Developing Economies. He served as Secretary of Labor in the Clinton
administration, for which Time Magazine named him one of the ten most effective
cabinet secretaries of the twentieth century. He has written fourteen books,
including the best sellers "Aftershock", "The Work of
Nations," and "Beyond Outrage," and, his most recent,
"Saving Capitalism." He is also a founding editor of the American
Prospect magazine, chairman of Common Cause, a member of the American Academy
of Arts and Sciences, and co-creator of the award-winning documentary,
INEQUALITY FOR ALL.