Save Medicaid Now

Here's How

Were I an ambitious Democratic governor, I’d immediately declare my goal of minimizing the negative impact of the pending Big Bad Bill tax and budget plan and, in particular, coming up with a proposal that guaranteed continued medicaid coverage for anyone currently enrolled. That might seem like typical political overpromise, but accurately acknowledges that state initiatives can moderate the legislation’s harmful mpact.

But will Democrats want to move in that direction? There’s a basic tension there between publicizing the predicted pain and acting to protect constituents from it. Should Democrats be attending the funerals of those whose deaths seem accelerated by the medicaid changes in an effort to fuel hostility to the GOP, or should they be doing whatever they can to keep people healthy?

This is complicated by the perception, fueled by the recent Ezra Klein- Derek Thompson book Abundance arguing that Democrats have been rejected by voters because of their failure to provide timely responses to problems. People want results more than partisanship, they argue, or, to recast the Chinese cliche, it doesn’t matter if the cat is red or blue as long as it rids us of rats,

The Republican mantra that government is, in fact the problem, protects them against similar criticism. If the government seems not to work, that confirms their basic bias about its chronic malevolent role.

Democratic message mavens may fear that my approach would help the GOP while making them vulnerable to “sky is falling” predictions, but that could be offset by simply comparing blue states that adopted this strategy to red states than didn’t, allowing Democrats to credibly argue “We fixed what they broke.”

Understanding the options requires acknowledging that there’s no single national medicaid program. Each state program is unique in terms of defining the benefits provided and the beneficiary population. And Federal subsidies to states also. As a result some medicaid programs offer a much wider menu of benefits to a much broader eligible population than those in a neighboring state do.

The Federal parameters merely set a floor, one that more than a few states generously and voluntarily exceeds. Since enactment of Obamacare offered a more generous option, 40 states including three – South Dakota, Oklahoma and Missouri, none of them bastians of democratic socialism – took it to expand coverage that have done so via referendums when state legislators balked.

That confirms the program’s ongoing public popularity

How deep support would be for financing state medicaid program with tax hikes that took a bite out of anticipated personal Federal tax savings is an open question– one well worth serious consideration.

There are those in both parties who prefer performative politics to helpful policies– more show horses than work horses– who find the idea of accentuating the negative is a cheap, reliable and attractive strategy and one that is far easier to implement than the tedious legislative slog required to actually change things.

So it is probably safe to assume more than a few elected Democrats will focus on documenting bad outcomes that can be ascribed to this legislation. I think that would be a mistake. Many voters yearn for a government that actually delivered the goods rather than responding by simply blaming its opposition predecessors for today’s problems– epitomized by the Trump strategy of ascribing all today’s problems to the Biden Administration.

In politics as in life generally, it is often more productive to play well the hand you’re dealt rather than demanding an investigation of whether the cards were marked. Congress is enactting a bad bill, but the opposition retains power to moderate its impact. I hope they have the empathy and wisdom to move in that direction.