Greg Sargent: This is The Daily Blast from The New Republic, produced and presented by the DSR network. I’m your host, Greg Sargent.
Johnathan Cohn: Thanks for having me on the show, Greg.
Cohn: Yes. There’s a couple of different baskets of cuts. The biggest one is a set of work requirements, which you probably heard about. You have to show that you’re working or you can’t stay on the program. There’s a second set of changes which sounds super technical about how often your eligibility gets checked and your enrollment, but makes it basically harder to stay on the program. There’s a third set of changes which affect the way states finance their benefits. And then there’s a couple of miscellaneous changes. There’s different justifications for all of them. They add up to about 800 to $900 billion. The thing to remember, I always say, is that you can go into the pros and cons for either one of them—but at the end of the day, if you take that much money out of Medicaid, it’s going to translate to less health care for people.
Cohn: Yeah. One way or another. The basic rule here is if money is coming out of Medicaid, for the most part, it is coming out of health care for people. Either it’s going to be fewer people covered, or it’s going to be fewer benefits for people who are on Medicaid. Now it won’t always look like that directly; a lot of times, it’ll be these technical adjustments on various formulas or procedures. But one way or another, less money is going into the program. And one of the realities, what’s going to happen is.... Again, sometimes people are going to lose coverage. Certainly, I count that as cutting benefits. What’s a benefit cut? Well, if you’ve taken someone off Medicaid, they’ve lost all their Medicaid benefits. So to me, that’s a benefit cut.
And then there’s an even more indirect way they can cut benefits, which is that states have a lot of leeway over what they pay for services. Remember, Medicaid is an insurance program. So it’s paying doctors, it’s paying hospitals, it’s paying therapists. Well, if you’re a state and you’re trying to save money, sometimes what you do is you tell all the hospitals and the doctors and the therapists you’re paying them less. That’s fine, but if you do that, it’s going to be harder for people who get those benefits to find providers, to find their services. So that, to me, is also an indirect way of cutting benefits.
Josh Hawley (audio voiceover): Republicans now, thanks to Donald Trump, are the party of the working class, Manu. You referenced the returns from the last election. The big majority of working-class voters voted for the GOP. That means now the GOP needs to deliver for them. And we do that by giving them tax relief. We do that by bringing down their health care bills. We don’t do it by cutting Medicaid.
Hawley (audio voiceover): This bill is not going to become law in its current form, not least because President Trump won’t sign it. Manu, I’ve talked to him about this personally multiple times. He has been crystal clear in public, too—no Medicaid benefit cuts. We need to give a tax cut to working people, not raise their taxes when it comes to health care, not take away their health care benefits. I hope this bill will get refocused on delivering relief for working families. That’s what we ought to be doing.
Cohn: Yeah. I was listening to that CNN interview and my my first thought was, If you didn’t tell me who was speaking and you told me that was coming from a liberal Democrat or somebody like Henry Waxman, the great senior and now retired member of the House who was like a father of the modern Medicaid program, I would believe it because it sounded like something they would say. And then I immediately thought ahead to the next election. And I’m thinking, If I’m a House Republican running for reelection and I voted for some of this, I’m going to be running in an ad. Someone’s going be quoting Josh Hawley in that ad. They’re just going to run his sound and say—especially if it’s a place like Missouri where they know Josh Hawley—Representative X voted for Medicaid cuts. Josh Hawley, MAGA Republican, said, “These will harm working-class voters.” You could literally quote him. So it was really remarkable. And the op-ed in the Times was really the same thing. The rhetoric was indistinguishable from what a liberal defender of Medicaid would say.
Cohn: Yes. The record of the Republican Party on Obamacare, on extensions of Medicaid, and then on the broad level—the whole idea of government health care programs—[is] hostile. It’s in the Republican conservative DNA. And look, principle conservatives have very honest intellectual arguments for why they think these programs are bad. They waste money. We should have to ... whatever. You’re a conservative, you believe that, you should argue that. That’s why we have these political debates. Josh Hawley surely knows about.... Let’s not forget when he was attorney general in Missouri, he signed on to one of the lawsuits challenging part of the Affordable Care Act. So my answer to “Does Josh Hawley not remember?” [is] I suspect at this point consistency is maybe not the most important value for him—or he’s done his own switcheroo.
And Missouri is your classic example. Why does Josh Hawley care about this so much? Because Missouri now has expanded Medicaid. They did it by ballot initiative. And by the way, they did it with a constitutional amendment—that is not something they can change easily. So they are on the hook for paying for Medicaid. If the federal government, one way or another, is paying less for Medicaid, the state of Missouri is in a whole lot of trouble financially because they’ve to find that money somewhere.
Cohn: Yes. They are desperate to.... The last whole two months—this entire debate as it has unfolded so far—has been one attempt after another by the Republicans to present their Medicaid cuts as something other than Medicaid cuts. We’re making the program more efficient. We’re actually protecting.... We’re really fortifying it so it really serves the most needy people. And you saw—especially in the last two weeks as they were trying to get the language together to put into a bill—there was, every day, a new leak of a new way they were going to cast Medicaid cuts, a new form for the cuts. It was almost like you could just see them trying to throw things against the wall. What’s going to work? What’s going to work? What’s not going to sound like a cut? But the problem is they want to take this money out of it, and there is no way to do it without hurting working-class voters.
Sargent: Well, the Republican Party really is devoted to screwing over Trump voters. That’s just the fact of the matter. The money is either going to go to the wealthy and corporations or to the working poor, and they can’t paper that over. That’s the fundamental math problem. So John, I hope Hawley is right that Trump won’t sign this bill. But I think one possibility is that Trump will just say that all the bill does is cut waste and fraud and abuse—and pretend it doesn’t cut Medicaid for the working poor. Then he’ll go and sign this bill or some version of these cuts anyway. What do you think?
Sargent: Isn’t the basic fact here that in essence, at its core, the Republican Party really still is a plutocratic party? There’s a major wing of the party that’s allied with the donor class. The big donors to the party are the hedge fund managers, the big CEOs, the billionaires. There’s just no getting around that for the Republican Party, is there? You see that tension playing out here in the sense that the Republican Party is delivering a massive tax cut for the very wealthiest and for the corporations, right?
Sargent: And I think that’s what’s going to end up happening. Jonathan Cohn, it’s so good to talk to you, man. Thanks for coming on.
Sargent: You’ve been listening to The Daily Blast with me, your host, Greg Sargent. The Daily Blast is a New Republic podcast and is produced by Riley Fessler and the DSR Network.
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