Twelve Republican House "moderates" sell out the ACA Medicaid expansion

Their letter vows to protect coverage for "vulnerable populations" -- from which low-income adults are pointedly excluded

Punchbowl News provides valuable daily intelligence as to the progress of the Republican reconciliation package, but they have this story exactly backwards:

The red lines begin: A dozen House Republicans say no to big Medicaid cuts

News: If you’re looking for a sign that House Republicans are getting worried about cuts to Medicaid, here it is.

A dozen House Republicans are warning GOP leaders that they won’t back a reconciliation package that includes massive cuts to Medicaid, according to a letter first obtained by Punchbowl News.

What the letter* actually does is sign onto the hard-right Republican plan, advanced by House Energy and Commerce Chair Brett Guthrie, to defund the ACA Medicaid expansion, which covers 20 million low-income adults. Ending the ACA’s 90% federal funding for the expansion population yields $561 billion in “savings” over ten years, according to the Congressional Budget Office. It’s the centerpiece of meeting the $880 billion 10-year cut target established for the Energy and Commerce Committee by the House budget resolution.

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The letter from these “moderates” adheres to the party line — voiced by Guthrie and given full expression in a Fox News op-ed by hard-core House Freedom Caucus members Andy Harris, Chip Roy and Eric Burlison — that defunding the ACA expansion “protects” Medicaid for the groups for which the program was originally intended. Here is the letter’s key paragraph (my emphasis):

We acknowledge that we must reform Medicaid so that it is a strong and long-lasting program for years to come. Efficiency and transparency must be prioritized for program beneficiaries, hospitals, and states. We support targeted reforms to improve program integrity, reduce improper payments, and modernize delivery systems to fix flaws in the program that divert resources away from children, seniors, individuals with disabilities, and pregnant women – those who the program was intended to help. However, we cannot and will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.

This passage signs onto the party’s Big Lie in the reconciliation drive, necessitated by Trump’s contradictory commands to “cherish and not “touch” Medicaid but also to adopt a budget resolution that instructs the House Energy and Commerce Committee to cut $880 billion in federal spending over ten years — almost all of which would have to come from Medicaid. The lie: they are not “cutting” Medicaid benefits — they are “protecting” Medicaid for the “vulnerable” populations for which it was originally intended. The Medicaid expansion population — adults with income up to 138% of the Federal Poverty Level — literally doesn’t count.

Somewhat cross-purposefully, the letter warns that “Cuts to Medicaid also threaten the viability of hospitals, nursing homes, and safety-net providers nationwide.” That’s true, but defunding the ACA expansion will do precisely that, albeit not for nursing homes. Perhaps more than one voice is at work in here.

The letter next appears to envision some fresh hell for the “low-income, working-class families” from whom they propose to strip Medicaid coverage (my emphasis):

To strengthen Medicaid, we urge you to prioritize care for our nation’s most vulnerable populations. Our constituents are asking for changes to the healthcare system that will strengthen the healthcare workforce, offer low-income, working-class families expanded opportunities to save for medical expenses, support rural and underserved communities, and help new mothers.

“Expanded opportunities to save for medical expenses” — what? This sounds like some kind Health Savings Account (HSA) nonsense cooked up by Senator Bill Cassidy in various ACA repeal/replace plans. Tax-favored savings accounts offered to low-income people to meet gargantuan medical bills are…freedom!

The ax is poised over Medicaid coverage for low-income adults. Repeal of the ACA’s 90% FMAP for this population will not instantly end all coverage for all adults with income below 138% FPL (the population currently covered by the expansion in the 40 states plus D.C. that have enacted it) — but no state will ultimately be able to afford that coverage without the FMAP.

Democrats and advocates working to stave off savage Medicaid cuts must focus relentlessly on the ACA expansion. As I’ve noted previously, the long-established reflex in defending Medicaid is to focus on the most obviously sympathetic populations — medically fragile children, disabled adults, the elderly in long-term care. Focusing exclusively on those groups without centering the expansion population right now plays straight into Republican hands — these are the groups they’re “protecting.” Medicaid advocates need to make it clear exactly who Republicans are selling down the river.

UPDATE, 5/1: Read the next chapter: We’re not cutting spending, we’re just reducing it. Really.

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* The letter is signed by Reps. David Valadao (Calif.), Don Bacon (Neb.), Jeff Van Drew (N.J.), Rob Bresnahan (Pa.), Juan Ciscomani (Ariz.), Jen Kiggans (Va.), Young Kim (Calif.), Rob Wittman (Va.), Nicole Malliotakis (N.Y.), Nick LaLota (N.Y.), Andrew Garbarino (N.Y.) and Jeff Hurd (Colo.).