GOP argues its health care bill does not ‘cut’ Medicaid

Republicans say they are trying to slow rate of growth.

WASHINGTON — Republicans, under fire for proposing health care legislation that would reduce Medicaid funding by hundreds of billions of dollars, have embraced an old argument that taking money from a program is not a “cut.”

At first glance, the new pitch seems at odds with the numbers. The Congressional Budget Office said Monday afternoon that the “Better Care Reconciliation Act” would reduce Medicaid spending by $772 billion over a decade. By 2026, Medicaid enrollment would drop by 16 percent among people younger than 65.

So, are there cuts or not? Asked over the weekend about the prospect of Medicaid cuts, Kellyanne Conway, counselor to President Donald Trump, said on ABC that Republicans were not in fact cutting funding for the government-run insurance program for the poor.

“We don’t see them as cuts,” she said.

Rather, Republicans want to slow the growth of Medicaid spending to preserve it.

Sen. Pat Toomey, R-Pa., also resisted the notion that the Senate bill would cripple Medicaid. He argued on CBS that it would “codify and make permanent the Medicaid expansion” that was put in place by the Affordable Care Act.

The explanation, echoed by many Republicans who see the bill as their best chance to repeal the Affordable Care Act, has reignited a debate over what counts as a cut, in budget parlance. The distinction has become a central talking point for Republicans to rebut claims that they are promoting a bill that could send the elderly packing from nursing homes and see children from low-income families go without medical care.

The nuance is also an important one for Trump, who campaigned on a promise that “there will be no cuts” to Medicaid, Medicare and Social Security.

At issue is whether the funding changes should be compared to the increases that would occur under current law, the Affordable Care Act, or whether the focus should be on the modest annual increases that would happen under the Republican bill.

The White House says Republicans are being victimized by a broken budgeting system that unfairly casts their fiscal restraint as callous cutting.

“Generally speaking, we spend more every single year on Medicaid,” Mick Mulvaney, the White House budget director, said in an interview earlier this month. “We are not gutting or filleting or kicking people off those programs. We are trying to slow the rate of growth of government.”

Debates over how to characterize such funding changes frequently occur when Republicans embark on policies that would shift money away from entitlement programs. President Ronald Reagan faced similar arguments when he wanted to reduce government spending in 1984, as did President George W. Bush when he tried to overhaul Social Security in 2005.

“This has not been just semantics but a political war for 40 years now,” said Douglas Holtz-Eakin, a conservative economist who led the Congressional Budget Office from 2003 to 2005.

Democrats also have not been immune. The Affordable Care Act slowed growth rates in the federal Medicare program, and Republicans made estimated $716 billion reductions a theme of 2012 election ads.

Holtz-Eakin said, semantics aside, that changes to Medicaid funding are intended to keep afloat a program that has become too costly for its own good. Describing slower spending growth as draconian cuts, he said, has been an effective tool for quashing conservative dreams of overhauling Medicaid. Holtz-Eakin said he survived as CBO director by avoiding using the word “cut” as much as possible because of its political connotation.

“In a political ad, the first thing you say is ‘cut.’ Then you go to the synonyms like ‘slash,’ “he said. “Pretty soon it gets to be a real powerful attack.”

Democrats contend the Republicans are twisting the numbers for their political purposes and that the impact of policy on the American people should be the bottom line. Nominal dollar increases, the Democrats argue, are meaningless if prices are rising and a growing population cannot get the health care services that it had been counting on.

In addition to the growthrate changes that Republicans have defended and said are not cuts, the Senate health care bill would also reduce federal funding to states that have expanded their Medicaid programs to include poor adults as part of the Affordable Care Act.

“The question of whether it’s an increase or a cut is really about how people experience health care and whether people will be covered,” said David Kamin, a New York University professor and former economic adviser to President Barack Obama. “From my perspective, it would best be described as a cut.”