Don't Forget Medicaid

As we wait for the white smoke to emerge from the "grand bargain" negotiations at the White House, most Americans are already aware of the Republicans' plan to dismantle and privatize Medicare and Social Security. But what many people may not realize is just how dangerous it would be to slash funding for a program that 60 million Americans rely on for their basic health care needs: Medicaid.

While it seems that just about every major industry or interest group has teams of lobbyists in Washington looking out for them, some of our most vulnerable citizens simply don't have a voice in a town where unfortunately, money still talks the loudest.

Why? Medicaid covers only the impoverished and disabled, so it lacks a traditional advocacy base. This may be news to Republicans -- but most poor people I know are spending all their time trying to find a job and put food on the table. Lobbying Congress just isn't on these folks' to-do list right now. Unfortunately, this means that my colleagues aren't going to spend a lot of time over the next 30 days sticking up for the 60 million Americans who rely on Medicaid to pay their medical bills. That's unfortunate, because if the Republicans are successful in turning the program into a block grant program that greatly diminishes funding to states, three awful things are going to happen -- people are going to die, more jobs are going to be lost, and health care costs and taxes will actually increase.

The fact is that Medicaid is the insurer of last resort for those that reside on the fringes of our economy. But is also pays over 60 percent of all nursing home care in America. So yes, cutting Medicaid will deny health care to a lot of poor women and homeless kids. But it will also force states to choose between three pretty awful options -- kick seniors out of nursing homes and onto the street, raise state tax rates to make up for the lost federal money, or change the rules to force younger family members to pick up the cost of their institutionalized relatives. One estimate suggests that the combined economic effect of these state-based adjustments will be an overall loss of two million jobs. And the worst of it all is that these Medicaid cuts won't actually end up saving the federal treasury any real money. While some of these patients will die from a lack of care, more will simply get shifted to more expensive crisis care at our clinics and emergency rooms, costing the system more in both the short and long run. In my home state of Connecticut alone, turning Medicaid into a block grant would jeopardize nursing home care to 17,000 seniors and disabled residents, impair coverage to over 280,000 children and result in nearly $7 billion less in Medicaid spending.

What is equally alarming is that if the Republicans are successful in dismantling Medicaid during these closed-door negotiations, they may kill health care reform along with it. You see, though most of the 32 million people who will get health care insurance under the Affordable Care Act get it through a tax credit that allows them to buy private insurance, about half of the newly insured are going to be new enrollees in Medicaid. Health reform expands eligibility for Medicaid by raising income thresholds and bringing more poor men into the program. But if Medicaid funding gets gutted, then one of the most likely responses by states is to further undermine the already-terrible rates that Medicaid pays doctors. That means that fewer doctors will accept Medicaid patients just as we need thousands more doctors to sign up the program in order to cover the influx of new enrollees. Thousands of new Medicaid patients could find that they have insurance in name only, which is only slightly less cruel than having no insurance at all. And guess what -- Republicans know this, which is why they are pushing so hard for huge Medicaid cuts.

There is a full-scale revolt brewing on Main Street now that people understand that instead of bringing forward any meaningful plan to create jobs in America, Republicans have been hell-bent on tearing apart Medicare and Social Security. But the result of this popular awakening cannot be that the cuts simply flow to Medicaid. Medicaid cuts shift costs to someone or someplace else. But more importantly, a choice to balance our budget on the backs of poor women and children and the disabled would speak something putrid about our nation. One of the great things that makes us Americans is the communal sense of decency and responsibility. This recession has forced more and more families to turn to Medicaid and millions more to say, "there but for the grace of God go I." If these cuts are allowed, we would be shredding the safety net that the most vulnerable members of our American family rely upon. Over the next few weeks, in order for justice and common sense to prevail, their voice needs become everyone's voice.

Congressman Chris Murphy represents Connecticut's 5th District and is running for the U.S. Senate