The G.O.P.’s War on the Poor

Four years ago, on the 50th anniversary of Lyndon Johnson’s war on poverty, House Republicans led by Paul Ryan issued a report declaring that war a failure. Poverty, they asserted, hadn’t fallen. Therefore, they concluded, we must slash spending on the poor.

..  it calls for the widespread imposition of work requirements for Medicaid, food stamps and other programs. But that would have the effect of sharply reducing those programs’ coverage.

.. This decline in coverage wouldn’t be the result of large numbers of people earning their way out of poverty. Instead, many poor Americans would, for a variety of reasons — poor health, job instability for low-wage workers, daunting paperwork imposed on those least able to deal with it — find it impossible to meet the requirements, and be denied aid despite remaining poor.

.. whatever the evidence, Republicans always reach the same policy conclusion. Was the war on poverty a failure? Let’s stop helping the poor. Was it a success? Let’s stop helping the poor.

.. And let’s be clear: We’re talking about the whole party, not just the Trump administration. In particular, Republican governors are fanatical about cutting benefits for their lower-income residents.

.. In Maine, voters overwhelmingly approved an initiative to expand Medicaid under the Affordable Care Act. But Gov. Paul LePage has refused to implement the expansion — a vast majority of which would be paid for with federal funds — despite a court order, and has declared that he’s willing to go to jail rather than see his constituents get health care.

GOP senators are rushing to pass Graham-Cassidy. We asked 9 to explain what it does.

The GOP senators insisted that the tens of billions in cuts to federal health spending proposed in the bill would not result in coverage losses because, they said, the states would have more flexibility.

..  The GOP senators insisted that the tens of billions in cuts to federal health spending proposed in the bill would not result in coverage losses because, they said, the states would have more flexibility.

Sen. Pat Roberts (R-KS):

“If we do nothing, it has a tremendous impact on the 2018 elections”

.. as a general rule the states do things better than the federal government does [things]. And that is essentially what the bill is

Jim Inhofe

..  I think the efficiencies that come with transferring the funding to the states can very well make up the difference between what the federal thing would be.

Sen. Ted Cruz (R-TX):

“It lets states innovate and adopt creative solutions”

the heart of the legislation takes the policymaking role of Washington and sends it to the states. It lets states innovate and adopt creative solutions to local problems, which vary state by state.

Jeff Stein

But it’s not just devolving power from the federal government to the state. It also involves a 16 percent cut in federal spending [upfront] and a 34 percent cut over the next 10 years.

.. Ted Cruz

CBO’s analysis throughout this process has been ridiculously slow, unreliable, and based on policy assumptions that are demonstrably false.

Jeff Stein

You really believe that cutting federal spending by 34 percent will not result in any other people losing their insurance?

Ted Cruz

What federal spending is cut?

Jeff Stein

Well, the Medicaid expansion would be sunset, for one, is my understanding.

Ted Cruz

The decrease in future rates of growth is not a cut. And it is only in the bizarre world of Washington that billions more money is characterized in the press as a cut rather than an increase, which is in fact what it is.

Sen. John Kennedy (R-LA)

.. I have sent four amendments to Lindsey [Graham] and Bill [Cassidy] that I think will strengthen the bill. The one I feel most strongly about is that I want the Medicaid work requirement — I don’t want it to be optional; I want it to be a requirement. Just like we did with welfare reform.

.. number two, I want to get us to give guardrails to the states to say, “You cannot use these moneys to set up a state-run single-payer system.” I don’t believe in it. I think it’s a mistake.

[Guardian reporter] Lauren Gambino

Do you think that kind of goes against the idea of states’ rights and being able to use this money [as the states want to]?

John Kennedy

No, no. We have plenty of federal rules that apply to every state, but we still agree with states’ rights.

John Kennedy

I think it spends scarce resources in a more rational manner. It will control costs. I like the idea that it encourages states to innovate.

Jeff Stein

How does it do that? Any of those things?

John Kennedy

Well, you need to read the bill.

Jeff Stein

Well, you’re voting for it, right? So what is the explanation for how it does those things?

John Kennedy

I am. Because it gives states added flexibility. Read the bill and you’ll understand.

 ..

Jeff Stein

The bill would cut federal funding to states by 34 percent over the next —

Richard Shelby

But it wouldn’t cut Alabama, though.

Jeff Stein

Well, do you think the other states should deal with —

Richard Shelby

Well, you see some of our states, four of our states, are getting a disproportionate amount of money from health care now. You know which ones.

.. Sen. Johnny Isakson (R-GA)

Jeff Stein

What is the policy explanation for the Graham-Cassidy health care bill?

Johnny Isakson

Policy explanation? I’m not into policy, so I don’t really know. I’m into facts.

Jeff Stein

[In a follow-up interview hours later on Tuesday] You were joking earlier, but what is the health policy in the Graham-Cassidy proposal that you like?

Johnny Isakson

More state innovation. More input from the states.

.. Johnny Isakson

The governors — I’m from a state that didn’t expand Medicaid, and the way we were going in health care looked like those states would actually be hurt worse than other states.

By going to block grants, back to the states, the control of money stays with the states, and you have less [un]predictability and external deviation in terms of funding.

.. Jeff Stein

So just a follow-up on that. It’s one thing to say the bill gives the states power — that’s one thing.

But it doesn’t just do that. It also cuts the money they have — some estimates say around 16 percent of federal funding.

Johnny Isakson

I’m not going to confirm that statement one way or another. I don’t know what the numbers are going to end up looking like.

Jeff Stein

Right, but if it does cut federal spending overall, would you support it?

Johnny Isakson

You know, those are dangerous questions. I’m waiting until I see the totality of the legislation to say whether I support the whole thing or not, anyway.

I’m not a no, but I’m not a yes either — and I’m waiting for my governor to respond to me with their input as well. It’s really key what they’re doing.

.. Sen. John Barrasso (R-WY):

“The governors who decided to expand [Medicaid] knew that they were going to lose federal funding”

..

Jeff Stein

I want to ask, in a big-picture way: What is the policy explanation for how this bill makes people’s lives better?

John Barrasso

It gets the money out of Washington, lets people at home make the decision, and gets state legislatures involved, and governors involved. It moves money out of Washington. It’s away from socialism.

Jeff Stein

CBPP says it will also reduce federal health spending on Medicaid and the exchanges by about [20] percent.

John Barrasso

I’d love to reduce federal spending on health insurance.

Jeff Stein

Right, but so it’s not just about moving power to the states — it’s also about cutting funding.

John Barrasso

It’s about moving power to the states, where money can be spent much more effectively.

Jeff Stein

How does it do that?

John Barrasso

Well, you have to read the formula and read the bill, and it will tell you how it moves money to the states and how much they get and how much they don’t get. …

Jeff Stein

There’s a concern from Republican governors who have come out and said, “This is too dramatic a cut in spending; we won’t have enough money to insure everyone.”

John Barrasso

You have to interview them on that.

Jeff Stein

Do you think they’re wrong?

John Barrasso

Well, it depends on if they’re states that expanded Medicaid or not. …

Jeff Stein

In the Medicaid expansion states, they still have a lot of people who rely on Medicaid expansion for health insurance.

John Barrasso

I opposed Medicaid expansion. I think the Supreme Court got it wrong [when it ruled in 2012 that Congress did have the constitutional authority to implement most of Obamacare].

The governors who decided to expand [Medicaid] knew that they were going to lose federal funding over time, and they’re objecting to that — but they knew it. You could say, “Some of them didn’t understand it, and so-and-so wasn’t there, and he wasn’t governor yet,” but they understood that this would be part of the process. So if they used the money poorly —

And my concern with Medicaid is that the people who Medicaid was designed for originally have been cut out of the process, because they’re still on the waiting list to get on Medicaid. I don’t know how much you understand about Medicaid, but this whole expansion of Medicaid went for healthy, working-age individuals — it did not go for the people who [Medicaid] was designed for, which was low-income women, children, and the disabled.

.. Sen. Chuck Grassley (R-IA):

“This is the last attempt to do what we promised in the election”

.. Chuck Grassley

Let me give you a political answer, and then I’ll give you a substance answer.

The political answer is that Republicans have promised for seven years that we were going to correct all the things that were wrong with Obamacare, and we failed the first eight months. This is the last attempt to do what we promised in the election.

The substance answer is that Obamacare starts with the principle that all knowledge about health care, and all decisions on health care, ought to rest in Washington, DC. The complete opposite of that is Graham-Cassidy, that Washington doesn’t know best and we’ll let each of the 50 states [decide what’s best].

How Democrats could bring down Obamacare repeal

Senate Democrats want House conservatives to think twice before supporting Speaker Paul Ryan’s Obamacare repeal bill — because Democrats believe they can strip out key provisions used to woo the right when the bill comes over to the Senate.

.. They plan to argue to the Senate parliamentarian that language that allows states to impose work requirements for Medicaid coverage and prohibits tax credits from being used on insurance coverage of abortion is not allowed.

.. the so-called “Byrd Rule” that restricts reconciliation bills from “extraneous” matters and provisions that don’t affect the budget.

.. The Family Research Council has already warned Republican lawmakers that the abortion prohibition is likely to get eliminated by Byrd rules because it does not have a pure budgetary impact.

.. Key House Republicans say it will be much more difficult to support the legislation without the work requirements and the abortion restriction.

.. Ted Cruz of Texas and Freedom Caucus Chairman Mark Meadows (R-N.C.), argue that the Senate should ignore any ruling from the parliamentarian that limits red meat additions to the repeal bill. But Senate leaders appear unwilling to consider such an explosive move, which could essentially eliminate the filibuster.

.. Anti-abortion groups raised concerns that there was no way to restrict the HSA money from covering abortion and comply with Byrd rules.