I’m not just a practitioner of political rhetoric, but also a connoisseur of it. I can appreciate a good argument and a well-turned phrase put forward by our ideological opponents. And, rather than get disturbed by what the other side says, I take their best work as a challenge. But what truly does get me angry is when our opponents not only lie, but do so with arguments that are insulting to the intelligence of the people we are trying to influence – the citizens of Pennsylvania and America.
So it’s no wonder that I find what Senator Toomey says about the impact of the Senate health care bill on Medicaid so utterly offensive. When I hear him speak on the plan he played a major role in devising, I can’t help but wonder, ‘how dumb does Toomey think we are?’ I can quickly answer: Not dumb enough to believe his dishonest, mendacious lies about that bill.
As we’ve explained in more detail elsewhere, the Senate health care bill changes Medicaid from a program in which half the costs of medical care and long-term care for seniors are covered by the federal government to one in which the federal government gives the state a fixed amount for each person receiving benefits from it. And that amount – the per-capita cap, as it is called – increases by some inflation factor based on how much the state spends per person in 2016.
Now this idea would be problematic even if the inflation factor was designed to keep up with the real increase in Medicaid costs. The per-capita caps won’t be adjusted if health care costs shoot up if, say, a new epidemic like Aids or Zika arises, or if there is a natural disaster, or if a new, life-saving (yet expensive) medical treatment or drug is invented.
Nor would the caps take into account the aging Pennsylvania population. As more of us reach the “old-old” post-75 stage of life and need not just medical care but long-term care – 2/3rds of which is paid for by Medicaid – our costs increase.
Beyond these problems, however, there is the issue of how fast the caps would increase. If they are set below the rate at which the costs for Medicaid go up, then the state would be short on funding from the federal government a growing amount every year. And that is exactly how the bill is written. Because we have aggressively adopted programs to reduce costs in our state, Medicaid costs have been going up slowly in Pennsylvania – only 3.9% year. That is far below the rate of increase in private insurance. It is projected to go up roughly at that rate in the future. But for two categories of Medicaid recipients, in the first ten years of the program, federal funding will go up only at the national rate of Medical inflation, which is projected to be 3.7%. Every year, we would lose just a bit more funding. And what’s worse, thanks to Senator Toomey’s efforts to cut Medicaid more deeply, in the second ten years, the caps would only increase at the regular inflation rate, which is projected to be 2.4% – well below the projected needed payments from the 3.9% annual increase.
Taking into account the reduction in federal funding for the Medicaid Expansion from 90% to 50% of costs, the Senate bill would cost the state $19 billion in federal funds in the first ten years and $54 billion in the second. Given that Pennsylvania already runs persistent budget deficits, which the Republicans who control the General Assembly are unwilling to close with new revenues, the Medicaid Expansion would have to be revoked in our state. And hundreds of thousands of seniors, children, disabled people, and mothers with small children (and mothers to be) will all face deep cuts in Medicaid benefits or will be thrown off the program through whatever restrictions our state lawmakers end up imposing.
And how does Toomey respond to these criticisms of the bill he not only supports but helped write? He says that the bill doesn’t really cut federal funding for Medicaid because (1) federal funding would still be higher than it is today and (2) the state can make up the difference.
Let’s stop and think about those answers for a minute. And, let’s bring them home to make it easier to understand how outrageous they are.
Suppose you work for me and I’ve given you a ten year contract that raises your salary 3% a year. Inflation runs at 2% a year, so after inflation, you get an increase of 1% per year in your purchasing power
Now, a year into our contract, I tell you that I’m going to cut your increase to 1.5% a year. And I say, “that’s not really a cut in your salary because what I pay you will still go up year after year.”
You would be furious, for three reasons. First, I made a promise to give you a raise of 3% and I just cut it in half. Second, given that inflation is going up faster than your pay, the purchasing power of your salary will be cut by .5% a year. And third, I’m trying to mislead you by lying when I say I’m not really cutting your salary at all.
Now suppose I also say, I’m not really cutting your salary because you can get another job to make up the difference (just like Toomey says Medicaid isn’t being cut because our state government can make up for the reduction in federal funding). And suppose we are in an economic crisis and there are no jobs in your field, so that is not really possible either (just as the state has no resources to make up for federal cutbacks in Medicaid.) And further, suppose that I’m friends with everyone else in our business and I’ve told them not to hire you even if they can (just like Toomey’s Republicans friends in Pennsylvania not only won’t increase state funding for Medicaid, but they are actively trying to reduce it).
But I have the gall, the effrontery, the chutzpah to say when I reduce your salary increase from 3% a year to 1.5% that I’m not cutting your salary.
Hearing that, you would be – should be – furious at me, not just for cutting your salary, but for lying through my teeth in denying that this is what I’m doing.
That’s exactly how we should react to Toomey’s dishonesty about the Senate bill. The bill itself is a horrible assault on the health and well-being of over a million Pennsylvanians who get health insurance through Medicaid (or the exchanges or private employers).
Toomey’s defense of it is the perhaps most dishonest and misleading rhetoric to come out of the mouth of a Pennsylvania politician that I can ever remember.
And, no – Pennsylvanians are not dumb enough to believe it.