To the Aid of Medicaid

In the progressive takes on Clinton’s speech last night, I was impressed and gratified how much attention is being paid to the significance of the Big Dog’s discussion of Medicaid. Up until now, I’ve felt pretty lonely in excoriating Democrats for having largely ignored this topic (virtually unmentioned at the Convention, I think, until Sister Simone Campbell’s speech yesterday; even HHS Secretary Kathleen Sebelius failed to go into it). Sure, earlier in the summer there was a flurry of interest in the Medicaid expansion provided for by the Affordable Care Act, once the Supreme Court ruled it was essentially optional for the states. But the dire, immediate and unambiguous Republican determination to wreck the basic Medicaid program, and the implications for all sorts of people–including the elderly and disabled–wasn’t making it into a lot of speeches that devoted vast rhetorical real estate to the less draconian and less immediate changes Republican propose for Medicare.

Here’s Ezra Klein’s excellent summary of the significance of Clinton’s discussion of Medicaid last night:

[T]here are three things worth noting about this Medicaid section. First, it’s a direct attack on Romney and Ryan’s claim that their budget won’t harm any seniors over age 55. As Clinton notes, much of Medicaid’s spending goes to nursing home care for seniors, and there’s no way Romney and Ryan can cut the program by a third without hurting the seniors who account for the plurality of Medicaid’s spending.

Second, it’s an inarguable attack on Romney and Ryan’s budgets. There are many, many places where one or both of the Republican candidates have been vague about they actually intend to cut or change, and that’s made it hard for Democrats to mount a sustained assault on them. But both Romney and Ryan have been very clear about how, and by how much, they intend to cut Medicaid. They will block grant it, and cap its growth such that it gets about $1.4 trillion less than it would under Obama. It’s a rare instance of specificity in both of their budgets, and so it can’t be waved away by promising details that will come after the election.

Third, it’s arguably the most important and concrete policy difference between the two campaigns. The Medicare changes get more attention on both sides, but Romney and Ryan don’t intend to touch Medicare for 10 years, they swear they’ll honor the Medicare guarantee, and at least in Ryan’s most recent budget, he envisions the exact same long-term spending path as Obama does. By contrast, Romney and Ryan intend to begin cutting Medicaid immediately, and independent analyses suggest that their cuts could throw as many as 30 million people off the program. If you want to see the difference between Obama and Romney’s vision for American policy, it’s probably the single starkest example.

Right, right and right. Reading a lot of folks this morning, it’s apparent that Clinton dispelled the implicit cynicism about “poor people programs” that so often keeps progressives from talking about Medicaid other than once in a blue moon. And regardless of the impact his speech has or doesn’t have on the presidential contest, I’m grateful for that.

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.