Reform's new 'lynchpin'

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John O'Connor
John O'Connor

The long-term care sector is reeling a bit, 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 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. 

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.

Many Republican lawmakers may soon have to make a tough 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.