As negotiations to raise the federal debt ceiling intensify, Medicaid is being eyed more closely for deep cuts. Since elected officials live in constant fear of senior citizens’ wrath, their latest plan is to hold the elderly harmless from any cuts while forcing younger low-income individuals off Medicaid rolls. Democrats make some vague assurances about coming up with “creative ways” to provide health care to low-income individuals, but that’s not terribly reassuring. One possible solution would be to open up the health insurance exchanges required by the Affordable Care Act to people with lower incomes, but the insurance subsidies still wouldn’t make coverage affordable for the very poor. The whole point of the ACA’s Medicaid expansion was to ensure that low-income people would have some basic degree of health insurance. Medicaid already provides care at a much lower price tag than private insurance–sometimes too low. But because we can’t allow even one crappy nursing home to go out of business, the poor will be offered the Hobson’s choice of unaffordable insurance or no insurance at all.
Perhaps the final plan won’t be as bleak as I’ve hypothesized here. But I’ve learned not to underestimate Democrats’ capacity to flinch and abandon good policy whenever a Republican so much as looks at them sideways.
