Yesterday, Donald Trump gave a speech to a joint session of congress and the media today is full of analyses about what it all means. Should they bother? After all, we now know that he is a pathological liar so why should we take anything he says on major policy issues seriously? For those interested in what he said, here is an article that gives the highlights and fact-checks them. Is anyone surprised that the speech contained a lot of cherry-picked data, misleading information, and outright lies?
While it is what he does that is worth watching carefully, his words do sometimes matter and should be taken seriously and Jon Schwarz says that while his speech in general was platitudinous, his ominous words about Medicaid should be taken seriously.
However, Trump did call for something specific that Republicans desperately want and that is completely feasible: brutal cuts to Medicaid.
Of course, Trump didn’t put it like that. Instead, he said, “We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out.”
That sounds nice, but is standard Republican code for attacks on Medicaid. In fact, it’s lifted almost word for word from Paul Ryan’s “A Better Way” plan for Medicaid, which states that “we believe states and individuals should have better tools, resources, and flexibility to find solutions that fit their unique needs.” Moreover, both during the campaign and afterward Trump has endorsed the standard GOP plans for Medicaid.
What this would mean in practice is two-fold.
First, the federal government would significantly reduce spending on Medicaid. Medicaid is run by individuals states, but currently the federal government pays a fixed share of each state’s costs — which rise during recessions or due to any number of unforeseeable events. Republicans have long wanted to change the funding mechanism to one in which the federal government pays only a fixed amount per Medicaid beneficiary (called a per capita cap) or a fixed amount per state (called a block grant), with states responsible for paying anything past that.
This would result in larger and larger cuts over time. Most GOP plans would permanently fix federal spending on Medicaid based on a future year, and then only increase the fixed amount annually at the rate of inflation, even though medical costs consistently rise faster than inflation.
But even more importantly, Medicaid is not just healthcare for the poor. It also pays the bills for over 60 percent of nursing home residents, and 40 percent of all national long-term care costs. And the number of Americans who need nursing home care is going to rise significantly over the next several decades as the baby boom ages into their eighties and nineties. Cutting Medicaid over this period is a recipe for people literally dying in the streets (or for luckier ones, on the foldout couch in their kid’s living room).
Second, if Trump gets his way, states will receive waivers to change Medicaid in various ways that would be both cruel and require nightmarish bureaucracies to enforce. Wisconsin Gov. Scott Walker wants to drug test Medicaid recipients. In Kentucky, Gov. Matt Bevin hopes to make beneficiaries without dependents work and pay premiums. Worst of all, states such as Arizona are attempting to enact lifetime five-year limits on Medicaid coverage, which could be a death sentence for people with diseases like cancer.
Of course, this proposal cannot be executed by Trump unilaterally and will have to work its way through Congress. The two things in its favor are that this proposal hurts the poor and thus the weakest group politically, while it is favored by Republicans and the oligarchs who really, really hate the poor. But a lot of the poor and the elderly in nursing homes are white and as the effects on such a move sink in, even those Trump supporters who have no problem with hurting communities of color may begin to have second thoughts.
But where Trump’s words mostly matter is when they can be interpreted by misogynists, racists, xenophobes, and anti-Semites as giving tacit support for their odious views and actions. His outrageous suggestion recently, that the attacks on Jewish cemeteries might be done by his political enemies or even Jews themselves in order to discredit him, is one example of him letting the people behind those attacks off the hook, further emboldening them.