In Ryan Budget Fight, Will Poor Folks Be An Afterthought?

If you’ve been reading Ezra Klein’s outstanding reporting at WaPo on Paul Ryan’s revised budget proposal, or Jonathan Cohn’s at The New Republic, or my own commentary here, you are probably aware that we all think the remarkable thing about what Ryan is trying to do is his unprecedented effort to decimate federal benefits and services benefitting the poor, across the board.

But that’s not what Ryan and his allies have been worried about, at all, as evidenced by this piece on GOP planning from Jake Sherman of Politico:

On the day before the budget rollout, top Republicans gathered in Speaker John Boehner’s smoky Capitol conference room with National Republican Congressional Committee officials and went over key phrases. Call the Medicare reform “bipartisan,” they were told. Frame it as helping to “fix Medicare and keep it from going bankrupt.” Be sure to point out that Americans 55 or older would not be affected. And say it gives seniors the choice of “staying in the current Medicare system or using the new one.”

Using this phrasing, 46 percent in an internal GOP poll — conducted in January — would support the Republican argument that Medicare is going bankrupt, Republicans were giving them a choice and the GOP is trying to preserve the program. The Democratic argument that Republicans were ending Medicare registered at 37 percent.

The precise, strategic sales job of the Ryan budget is a far cry from last year’s clunky rollout, and a sign that Republicans have learned some lessons in political strategy on the divisive issues underlying the Ryan vision.

Medicare, Medicare, Medicare. It’s all about Medicare, and how seniors perceive the Ryan budget as affecting Medicare. Take care of that problem, and it will be clear sailing for the Ryan budget, its proponents clearly believe. And they may well be right, since a lot of Democrats don’t really want to talk about anything else, either.

Indeed, in the entire Sherman piece, the word “poor” appears exactly once, at the tail end of a Democratic litany of criticism of the Ryan budget that begins, of course, with “Medicare.”

But here’s the thing: Ryan’s proposed changes to Medicare, which he’s watered down and backloaded, are probably not even the most significant health care provisions in the proposal. Here’s Jon Cohn:

[I]t’s not the Medicare population that takes the biggest hit this time. It’s the Medicaid population. For starters—and this was the very first thing Ryan mentioned at his press conference—Ryan would repeal the coverage expansions of the Affordable Care Act. This is old news, I know. But few people seem to appreciate the impact. Take away the Affordable Care Act and you take away insurance from the 30 million people who are supposed to have it come 2014, when the law goes into full effect. About half of them are supposed to get that coverage from Medicaid.

Now throw in Ryan’s proposal to convert Medicaid into a block grant, under which the federal government would no longer guarantee insurance coverage for everybody that meets eligibility standards. Instead, the government would simply write checks to the states, for predetermined amounts, and let them figure out how best to spend the money. To generate the savings his budget needs, he’d reduce the value of those grants over time, relative to health care costs and current projections.

The bottom line on health care is this, Cohn concludes:

Altogether, the CBO says, spending on Medicaid, the Children’s Health Insurance Program, and subsidies for private insurance would be nearly 75 percent lower in 2050 than projected under current law. (See figure below, from the CBO report.) Let that sink in for a minute: Ryan wants to reduce the government’s investment in helping people get health insurance by three-quarters.

Will that “sink in” when the public debate over the Ryan budget gains momentum? Or will Democrats collude with Republicans in making it all about Medicare, and whether or not seniors can or should trust Republicans assurances that they’ll let the rest of the population go to hell in a handbasket before they’ll touch their benefits! (Matter of fact, even an exclusive focus on seniors should lead back to Medicaid, since low-income seniors, and those receiving long-term care assistance, are its disproportionate beneficiaries).

Yes, yes, I understand seniors tend to vote in high numbers, and that if Republicans lose the advantage among white seniors they enjoyed in 2008 and 2010, they are toast in 2012. I also understand that Ryan and company really do want to abolish “Medicare as we know it,” and for that matter, Social Security as well, and that’s a very bad thing that progressives have a responsibility to expose and fight.

But I also know that poor people don’t have a lot of political clout in this country, and that progressives have a special responsibility to defend them, whether or not they are swing voters or reside disproportionately in battle-ground states.

You just can’t look objectively at Ryan’s budget and make it anything less than the most audacious attack on federal responsibility for the poor and disabled since the Great Society. It makes the Reagan budgets of the early 1980s look kind and generous. Let’s please don’t forget that as the debate unfolds.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.