Medicaid just might sink Trumpcare

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John O'Connor
John O'Connor

The long-term care sector is in a tizzy, thanks to two recent developments.

One is President Trump's budget proposal for the next fiscal year. The other is a Congressional Budget Office assessment of the House health bill.

Each initiative promises to severely gut Medicaid outlays in the name of deficit reduction. But the reality many providers are prepping for is this: if it was tough to deliver champagne services on a beer budget, how will that be even remotely possible on what amounts to bread-and-water rations?

So why do the powers-that-be find Medicaid such a tempting piñata? It's a fair question.

Truth be told, there are two main drivers. But only one is usually mentioned in polite company.

The happy-to-discuss reason is this: Medicaid expenditures have been on the rise, and the trending is for much more of the same. In many states, Medicaid expenses now exceed outlays for kindergarten-through-grade 12 education. Moreover, the Affordable Care Act (better known as Obamacare) essentially incentivizes states to expand the tent. So if you want to start restoring some fiscal sanity at the state and federal levels, Medicaid is an obvious place to begin.

But there is a more insidious reason for the targeting: Medicaid is seen by many in Washington and elsewhere as a program primarily for layabouts with dark skin. Bear in mind I'm not suggesting the sentiment has merit. Far from it. But it would be naïve to believe that such a prejudice is not in play here.

Nor is that attitude particularly new. During the Reagan administration in the 1980s, Cadillac-driving welfare queens were regularly cited as a reason to trim back Medicaid outlays. Never mind that such fraudsters were about as easy to spot as rainbow-colored unicorns. Regardless, it's probably safe to say it is not a universally beloved program.

But Medicaid just might become the poison pill that sinks Trumpcare.

That's because planned program cuts won't be limited to poor people with darker complexions. As it turns out, most Medicaid recipients happen to be white. Moreover, quite a few are card-carrying members of AARP. A more accurate name for that organization might be 40 Million Older Voters You Really Don't Want To Tick Off.

It will indeed be a brave member of Congress who is willing to incite the wrath of AARP's rank and file. And as Medicaid coverage fades and health costs for the elderly quadruple (two very likely outcomes, according to the CBO report), those angry seniors just might be looking for a little Election Day payback.

It has been noted that President Trump loves bullet points and visual aids. In fact, German Chancellor Angela Merkel reportedly brought a 1980s map of the former Soviet Union when she met with him recently. She allegedly did so to show that Russia might be interested in reclaiming its old borders, which stretch westward for hundreds of miles.

So here's my advice to anyone meeting with the President soon: Bring some bullet points that reveal how many voting seniors there are in each Congressional District. Show that there will be 238 Republicans up for re-election next year. And indicate that in order to regain control, Democrats need a net gain of only 24 House seats. You may also want to point out that there are 23 Republican incumbents in congressional districts where Hillary Clinton received more votes last November. Then explain in a clear voice that it would not take much to restore gridlock.

On second thought, maybe such an effort won't be necessary. Many Republican lawmakers may soon have to make a big decision: keep their day jobs or support a man who sees loyalty as a one-way street. My guess is that in tight races, that may not really be much of a choice.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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