On preventing the gutting of Medicaid
NJ Rep Jeff Van Drew, a lapsed Democrat, frames the fight to come
I have not posted for the last couple of weeks because I’ve been engaged, as co-chair of the healthcare committee of Blue Wave New Jersey, in the effort to stop the savage cuts to Medicaid written into the House Republican budget resolution that passed on a strict party line vote on Tuesday night.
New Jersey has three Republican House members: Jeff Van Drew, a lapsed Democrat (NJ-2); Chris Smith, who voted against ACA repeal in 2017 (NJ-4); and Tom Kean, who represents one of the country’s most competitive districts (NJ-7).
Below is a version of a note that went to the Blue Wave healthcare committee that I think captures a couple of key points about where we’re at in the battle to prevent the gutting of Medicaid.
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It should be clear that by passing their budget resolution on Tuesday night, Republicans took only a first step toward passing savage cuts to Medicaid, SNAP and other vital programs. The House budget resolution only sets spending targets* for actual spending bills that must be written in coming weeks, and the main battle will be over the content of those bills.
No one has made that point clearer than NJ-2 Rep. Jeff Van Drew, a former Democrat turned MAGA who said repeatedly that he does not want to cut Medicaid -- then caved at the last minute and voted for the budget resolution. His post-mortem gives us our marching orders:
“As much as I wanted to see a different budget resolution, I ultimately voted for it because it is essential to move the budget process forward so real negotiations can begin,” Van Drew said. “Americans made it clear they want a better budget – one that reins in spending while protecting the services families rely on.”
The congressman noted that President Donald Trump and other GOP leaders have said they want to maintain Medicaid funding; if there are Medicaid cuts in the eventual legislation that Republicans try to pass, Van Drew said, he’ll vote against it. (The budget resolution that passed today directs the House Energy & Commerce Committee to cut $880 billion in spending, which many people – including Rep. Frank Pallone, the top Democrat on the committee – say would inevitably come in part out of Medicaid.)
Van Drew caved this week -- will he cave again? Maybe. But maybe not -- and he's more likely to hold out if a good handful of Republicans in purple districts, or in districts with heavy Medicaid enrollment -- join him. In the weeks to come, calling voters represented by House reps and senators who have reason to be queasy about these cuts, and asking them to call their reps and senators, may be key. In 2017, to stave off ACA repeal, we called voters in Maine and asked them to call Susan Collins -- who did vote against repeal.
Countering the “waste, fraud and abuse” lie
One more note, on a key talking point in the battle to come: When Republicans write their bills cutting Medicaid, a key lie will be that they're only cutting waste, fraud and abuse. In making that case, they will misrepresent CMS's own accounting of "improper payments" -- which are a small percentage of payments overall, and mostly a matter of insufficient documentation, not money wrongly spent. The Center for Budget and Policy Priorities explains here. Key paragraph:
It’s important to note that most of the improper payments are made for eligible health services for people who were eligible for Medicaid; the issue is that proper documentation for the payments is missing. That means that the improper payment rate is a measure of procedural errors ꟷ not a fraud rate, nor is it an accurate count of funds that were misspent. However, during House Budget Committee consideration of the House budget resolution, which proposes potentially $880 billion or more in Medicaid cuts over ten years, some Republican lawmakers cited the 2023 overall improper payment data and seemed to suggest it meant that they could cut $50 billion a year in waste, fraud and abuse.
UPDATE: An email from Stan Dorn, ex of Families USA and now with Unidosus, widens the lens, and, in the section bolded below (my emphasis), raises an alarm (that I hope is somewhat overstated):
[First,] the cuts to Medicaid and SNAP proposed by the Budget Resolution are the largest in U.S. history. See our blog posts here and here. Previous cuts resulted in millions of people losing Medicaid and SNAP. The current, even larger cuts would almost certainly be worse.
Second, if the Budget Resolution passes in anything like its current form, huge Medicaid and SNAP cuts will be inevitable. That is because, unless the program cuts are scored by CBO as achieving the requisite savings, the GOP will not be able to enact their tax cuts. A vote for the budget resolution today just means that representatives will need to make a new apology down the road: "I'm so sorry that I had to vote to take away your Medicaid and your SNAP, but I had to do that, otherwise your taxes would go up." If they don't stop the Medicaid and SNAP cuts now, it will likely be too late to stop them later, as a practical matter.
Third, the American people are not demanding cuts to Medicaid and SNAP. In fact, public opinion polls show Americans oppose cuts to these programs. Across party lines voters believe these programs spend the right amount or should spend more, not less.
I have been assuming that the main locus of the fight now will be when House Republicans write actual appropriations bills with huge cuts to Medicaid and SNAP — and that as in 2017, when ACA repeal bills written to accord with a prior reconciliation budget resolution were voted down, we have a good chance to make the spending bills fail. Stan’s email suggests that the crux will come when the Senate takes up the House budget resolution.
Per Punchbowl, attempted Senate changes to the House resolution could go in two directions: more spending cuts to cover the Senate leadership’s goal of even more extensive tax cuts (rendering all the 2017 tax cuts permanent) and to satisfy House hardliners, or fewer cuts to Medicaid and SNAP, as some House moderates who caved late and voted for the resolution purported to assume.
The battle over the rival Senate and House budget resolutions will be more extended than I realized, with voting projected in early April, according to Punchbowl.
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* Before the House budget resolution becomes a blueprint for legislation, it must be reconciled with the Senate budget resolution passed the week prior, which did not focus on social programs or mandate the savage cuts in the House resolution.
Keep the momentum going, Sprung!