Many Republican members of Congress have been leery of cuts to Medicaid, afraid of being tarred by Democratic attack ads. The recently released House Energy and Commerce Committee draft proposals should help them rest more easily because they avoid the classic Republican mistake: appearing to care more about saving money than saving lives.
Democrats have accused the GOP of being cruel to the average citizen since the Great Depression. President Herbert Hoover resisted direct federal aid to the unemployed, arguing it would cost too much and irretrievably damage “the American system” of government.
Hoover might have been right in theory, but when 25% of workers were without a job and the economy continued to worsen, voters were in no mood to put theory ahead of help.
That’s why President Franklin D. Roosevelt won in a massive landslide, ushering in the New Deal and nearly 50 years of Democratic Party dominance.
The public has moved to the right in the last few decades, especially after President Ronald Reagan gave birth to a three-decade economic resurgence with tax cuts and deregulation. But they still believe they are entitled to a floor beneath which they will not be permitted to fall. Medicaid is a part of that floor.
Republicans today accept this premise, even if some do it grudgingly. But their attempts to reduce the rate of growth in spending on the programs that comprise the planks on that floor often raise questions about their sincerity.
The classic GOP method treats entitlement spending as a fiscal problem rather than a human one. It looks at the expected total spending in year X and first seeks to reduce that to something considered manageable. Block-granting Medicaid to the states or reducing Federal Medical Assistance Percentage reimbursement rates for Medicaid are just two examples of this approach frequently floated by budget hawks.
These ideas are always fiscally sound but politically unpopular. That’s because they never get into the details of the program to determine which current recipients will bear the brunt of the reduced spending.
This means millions fear that programs they rely on will be taken away.
It’s understandable why Republicans do this, especially if they are primarily concerned with saving money. But that makes them wide open to the often demagogic attacks Democrats launch that accuse them of pushing granny off the cliff.
The House committee plan avoids these mistakes. Instead of pushing for across-the-board cuts in reimbursement rates, it makes targeted changes that are politically defensible.
The proposed work effort requirements are a perfect example of this approach. The committee proposes to require every able-bodied Medicaid recipient between the ages of 19 and 64 without dependents to work, go to school, or engage in community service for at least 80 hours a month.
That will surely result in some people forfeiting their Medicaid eligibility rather than abiding by the rules. But a recent poll found that 62% of Americans and 82% of Republicans favor these requirements.
It’s easy to see why. People consistently say they want the government to be generous to those who need it, but to cut off those who don’t.
This requirement amounts to spending 20 hours a week doing socially useful activities. Since the proposal exempts disabled people, those with dependents, pregnant women, and many others who would have a legitimately hard time complying, it’s clear that those who don’t meet the new rules don’t want to do so.
In this case, Americans do not see the spending cut as a cruel effort to prioritize saving money over saving lives. They see it as a way to ensure that the people who get help deserve it.
Many of the committee’s other proposals rest on a similar foundation. Some ideas effectively prevent illegal immigrants from getting Medicaid, while others penalize states that try to put them on the roster.
Again, people across the political spectrum, but especially those open to voting Republican, think that’s just common sense.
Other provisions institute more frequent checks to ensure someone is actually eligible for the assistance. This is also common sense: Why should someone get money from the taxpayer if they now earn enough to help themselves?
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Republicans can cut the rate of entitlement spending growth, but only if they make a moral argument instead of a fiscal one. People will happily support cutting off shirkers or giving well-off recipients of Medicare or Social Security a benefit haircut.
What they won’t do is choose to save money over saving lives. So long as the GOP keeps that fact in mind, they should be able to find the savings they need and live to tell the tale.
Henry Olsen is a senior fellow at the Ethics and Public Policy Center and a veteran political analyst. He hosts Beyond the Polls, a podcast about American elections and campaigns.