Since Rep. Paul Ryan introduced his budget blueprint in April, Democrats have held countless news conferences and issued even more press releases condemning the plan — as they say — to eliminate, end or kill Medicare as we know it.
Yet, for all the Democrats’ posturing and campaigning against Republican plans for Medicare, the GOP budget actually makes more immediate and deeper cuts to Medicaid. But Democrats haven’t been blasting the GOP Medicaid plan with nearly the same fervor, even though Republicans would cut about $750 billion from the program during the next decade and end the guaranteed federal match for states.
With intense budget negotiations on the debt limit under way, health care insiders think Democrats won’t budge much on Medicare now that they have a significant campaign chip in their pockets: Kathy Hochul’s upset win in New York’s 26th Congressional District is Exhibit A of the power of Medicare.
And that makes advocates worry that Medicaid cuts are more likely to come out of budget negotiations led by Vice President Biden.
Medicaid covers more than 50 million people, including low-income children and seniors in long-term care, but it doesn’t pack the same political punch as Medicare. Some observers say that’s due to the lingering perception that Medicaid is just a program for poor people that holds a much less broad-based appeal.
That perception is definitely part of the challenge in communicating Democratic opposition to the GOP’s Medicaid plans, Rep. Robert Andrews (D-N.J.) told POLITICO.
Medicaid “doesn’t quite have the same political dynamic” as Medicare, Andrews said.
Medicaid faces numerous GOP efforts to slash program spending as states grapple with massive deficits and leaders in Washington try to hammer out a budget deal. Republicans have pushed block grants and easing maintenance-of-effort requirements as their preferred methods of controlling Medicaid costs. Last year’s health care reform law raised the stakes for Medicaid even higher, because the program is expected to add 16 million to its rolls in 2014.
While advocates say Democrats have drawn a clear line against the GOP’s Medicare plan, they’re less certain of the party’s stance on Medicaid. At this point, they’re unsure what will come out of the Biden negotiations on the debt ceiling, but they believe cuts are on the way.
Some Democrats have voiced their dedication to preserving the Medicaid program as is. “We must protect Medicare; we must protect Medicaid,” Assistant Democratic Leader Jim Clyburn of South Carolina told reporters after a White House meeting on Thursday.
But they’re not exactly blasting that message from the rooftops.
Aside from Sens. Robert Menendez of New Jersey and Jay Rockefeller of West Virginia, very few Democrats have put Medicaid front and center, a health care advocate said.
“The message has been Medicare, Medicare, Medicare,” the advocate said.
Recent polling, however, shows the public may look more favorably upon Medicaid than previously thought. A Kaiser Health tracking poll released in late May found 60 percent of respondents support the current Medicaid structure, 35 percent support block grants and 53 percent favor no Medicaid reductions. Further, about half said they have a personal connection to Medicaid, either because they participate in the program or know someone who does.
An April poll from Greenberg Quinlan Rosner showed support for Medicaid was on par with that for Medicare.
As Democrats continue to hammer home the Medicare message — and promise to make it a central campaign issue in 2012 — staffers for leading House and Senate Democrats in a closed-door meeting last week urged Medicaid advocates to get their message out. The underlying message, according to advocates who attended the meeting, is that congressional Democrats would rather let outside groups do the heavy lifting on Medicaid.
“They know they need to protect Medicaid, but they don’t understand it,” said an advocate who is a former Hill staffer. Members “tend to be wealthier and older, so they just don’t have that interaction, and they don’t speak from any knowledge around it.”
Still, another Democratic health lobbyist said last week’s meeting showed commitment to fighting the GOP’s Medicaid proposals.
“It’s fantastic that such a meeting took place,” the lobbyist said.
Days after the meeting, Democrats on the Energy and Commerce Committee started to push back by releasing district-specific numbers on how the GOP’s Medicare and Medicaid plans would affect constituents.
Menendez, who heads the Democratic Senatorial Campaign Committee, acknowledged in a conference call last week that Medicare has garnered much of the party’s attention. But he drew a hard line against the GOP’s Medicaid proposals.
“Medicaid [cuts], certainly in the context of block granting, [are] also not acceptable,” Menendez said.
Besides Menendez, Rockefeller has been the most outspoken on the issue. On the eve of President Barack Obama’s April speech on his long-term budget view, Rockefeller issued a stern warning not to cut Medicaid.
Obama gave few hints of his Medicaid plans in the speech, but he said changes to entitlement programs are necessary.
“I guarantee that if we don’t make any changes at all, we won’t be able to keep our commitment to a retiring generation that will live longer and face higher health costs than those who came before,” Obama said.
CORRECTION: An earlier version of this story incorrectly attributed a quote to House Minority Whip Steny Hoyer rather than to Assistant Minority Leader Jim Clyburn.