Is Medicaid Being Cut? Depends Who's Counting

Democrats say it's being gutted, but Republicans say it's increasing
By John Johnson,  Newser Staff
Posted Jun 29, 2017 10:00 AM CDT
Medicaid Semantics Fight: Is It Being Cut or Not?
Senate Majority Leader Mitch McConnell.   (AP Photo/Alex Brandon)

The weird new fight regarding the Senate GOP's health care plan is one of semantics. Democrats insist that Republicans are slashing Medicaid, while Republicans say that Medicaid is actually increasing. Witness President Trump's tweet on Wednesday: "Democrats purposely misstated Medicaid funding under new Senate bill - actually goes up," he wrote. Kellyanne Conway and Newt Gingrich have made a similar case. So who is right? In the wonky world of budget parlance, both sides can make a case. Explanations:

  • He's right, but ...: "In a literal sense," Trump is correct, explains a Wonkblog post at the Washington Post. Under the GOP plan, the total amount spent on Medicaid would grow, slowly, from 2017 to 2026. "But the accounting he uses to show Medicaid spending is wildly divergent from the way budget analysts, policymakers and many lawmakers account for spending levels." It's all about what is considered "baseline."
  • The numbers: The CBO says that under current law, the federal government would spend $4.62 trillion on Medicaid through 2026. Under the Senate bill, spending would be $770 billion less. "Opponents of the GOP bills call that a cut," says the fact-checking blog Politifact. "The CBO calls that 'reductions in outlays.' Gingrich is saying it’s an increase." After a lengthy assessment, the site rates Gingrich's claim "Half True." It previously gave Conway a "Mostly False" rating.

  • Reductions vs. cuts: The CBO projections "take into account policies that would be changed by the bill, as well as factors such as how much the population is expected to grow and age, and how quickly medical costs are rising," notes USA Today. "Democrats argue that the Senate plan should be compared to current law—and that reductions in planned spending amount to cuts."
  • One analogy: A story at Fox News calls attention to this tweet by former White House press chief Ari Fleischer: "Your salary today is $50k. Your boss promises it will be $100k in 10 years. Instead, u get $75k. Did you get a $25k raise or a $25k cut?"
  • Fewer enrollees: ABC News explains one reason why Medicaid costs would be lower under the GOP plan: "Medicaid would see 15 million fewer enrollees over the next decade, the CBO said. Enrollment would decline from two groups—people who are currently eligible for Medicaid and people who, under the ACA, would be eligible in the future as more states continue to expand Medicaid."
  • Change in allotment: As things stand now, the "federal government provides states with a percentage of their Medicaid funding based on a formula of how much a state actually spends," explains Business Insider. Under the Senate bill, "states would receive a set amount of money based on the number of people on Medicaid in that state. In other words, federal funding would grow in raw terms as the US population grows and the total number of people on Medicaid increases, but the amount per person would not be as generous as the current system."
  • One view: Samantha Bee offers a primer on Medicaid on her Full Frontal show, one that is decidedly anti-Republican. "That's not ObamaCare repeal, that's JohnsonCare repeal," Bee said, adding, "Please don't kill Medicaid—it's only 52 years old." See the video (with the usual warning on language).

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