Trump Isn't President Yet, But the War Over Medicaid Has Already Begun

This past Christmas the New York Times ran an op-ed by Gene B. Sperling, the former director of the National Economic Council, on the GOP’s war against Medicaid. Sperling explained how Democrats are preparing themselves for a battle with Republicans over Medicare, but how a focus on that program “may inadvertently assist the quieter war on Medicaid,” a war that is much more certain.

Speaker Paul Ryan and Tom Price, Trump’s secretary of health and human services pick, have already made proposals to hack away at the program via block grants, a plan Trump has said he supports. Sperling has done the math: the cuts, combined with the proposed ACA repeal, would cut Medicaid and the Children’s Health Insurance Program funding by about $2.1 trillion over the next 10 years—a 40% cut.

Sperling also points out that the destruction of Medicaid, and the fact that Democrats might overlook it, could plausibly fit into what seems like a developing Trump strategy:

If Mr. Trump chooses to oppose his party’s Medicare proposals while pushing unprecedented cuts to older people and working families in other vital safety-net programs, it would play into what seems to be an emerging strategy of his: to publicly fight a few select or symbolic populist battles in order to mask an overall economic and fiscal strategy that showers benefits on the most well-off at the expense of tens of millions of Americans.

But the GOP’s “Quiet War on Medicaid” might hit a roadblock before Trump has a chance to move on the issue. Roy Cooper, who was recently and narrowly elected North Carolina’s governor, is trying to expand Medicaid in the Tar Heel State and cover an additional 650,000 people. If he’s successful, North Carolina would become the 32nd state to expand the program under the Affordable Care Act.

That’s not as simple as it might sound. In 2013 former GOP Governor Pat McCrory and the state’s Republican legislators approved a law banning local lawmakers from expanding the program unless they get the state’s (GOP-controlled) General Assembly to sign off. A primary sponsor of that bill was Republican State Senator Bob Rucho, who gained national infamy in 2013 when he tweeted that, “Justice Robert’s pen & Obamacare has done more damage to the USA then the swords of the Nazis, Soviets & terrorists combined.”

Gov. Cooper claims that the 2013 legislation strips him of his authority and impairs his ability to act on behalf of the state’s citizens. He’s filed paperwork with federal regulators and is looking to get the necessary funds secured before President Obama leaves office. Inevitably the move has met with vigorous resistance from local Republicans and a legal fight seems imminent.

Last year Louisiana became the first state in the Deep South to adopt a Medicaid expansion after Democratic Gov. John Bel Edwards signed an executive order to begin the process. “I don’t look at this as some revolutionary thing— this is just the right thing to do,” Edwards said after signing the legislation.

There wasn’t a ban on expansion, like in North Carolina, but Edwards ran into a major obstacle right away: Republicans lawmakers refused to fund any additional workers at the agency. The state had to rely on assistance from non-governmental groups and contributions from some of the state’s existing healthcare programs.

But as Talking Points Memo has reported, the effort’s most important innovation was the use of food stamp data to enroll people. The two programs have similar income requirements:

In Louisiana, SNAP recipients are in the process of receiving letters informing them of their eligibility for Medicaid expansion, and asking them to answer just a few more questions to finalize their enrollment. Going forward, Louisianans applying for SNAP will also have the option to apply for Medicaid Expansion at the same time, making the processes a “one stop shop..."

Louisiana’s Department of Health has been able to enroll thousands of people into Medicaid as a result of Edwards’ executive action but the roadblocks demonstrate how, even if Cooper is able to strike down the law, the fight is far from over.