Politics. If Republicans hadn’t tired of being called jerks, we might not be in this mess. The eight years of President Ronald Reagan’s term, during which he was frequently accused of heartlessness, or worse, compelled President George H.W. Bush to call for compassionate conservatism.
Republicans, no longer the party of “no,” raised taxes, advocated for, and enacted seeping policies to expand the federal bureaucracy, and passed the biggest expansion of social benefits, Medicare Part D, since the 1960s.
There is nothing like spending other people’s money to make a political leader feel fulfilled.
Beneath the surface, though, it lingers. The tension between domestic fiscal conservativism (excluding defense) and libertarianism with few policy or ideological anchors; scolds and frat bros, if you will.
Naturally, there will always be more people looking for a good time – and let me assure you, being the party of “no” is not where that is at – and the current race for Speaker of the House reflects that.
So far, the bids to assume a spot in the presidential line of succession has touched some of the gradients between the finger wagers caucus (Rep. Jim Jordan) and beer me conference (Rep. Kevin McCarthy.)
What has yet to appear is someone with the qualities needed for such interesting times, but they will.
Policy. Once the politics of the Speaker’s race get resolved, deficit politics will inevitably continue their emergence. The nasty problem is that, unlike the 1940s, when we last had such monumental debt to GDP ratios, state and federal governments are all up in the economy’s business.
Austerity budgets like those envisioned by the party of “no” would have a negative, perhaps even disastrous, effect on GDP unless the House can focus on non-productive spending.
For example, it is an open secret that states which expanded Medicaid frequently classify people that qualify under traditional eligibility criteria as part of the expansion population, which receives a 90% match from the federal treasury.
It is no surprise that non-expansion states have moved quickly to clean up their rolls via the redetermination process, while states like California lag well behind. When they catch up, these states are likely to have higher Medicaid enrollment when the process ends next year.
These incentives support ELV’s confidence that their loss of enrollees was frontloaded.
Leaving aside the political power of anecdote, the evidence that the pricier Medicaid expansion population of working-age adults provides more or better care, relative to the traditional populations, is scant. Reimbursement levels to providers, especially if you exclude skilled nursing homes and acute care hospitals, are generally at and often below cost. Overall health and life expectancy are worse, not better, since passage of the ACA.
On the other hand, if deficit politics lead the House down the road toward reductions in Medicare reimbursement, as President Barack Obama did to finance the ACA, the result could be deleterious.
Power. To turn the aircraft carrier-sized problem that that is the budget deficit will require President Bill Clinton-level politicking. Having defeated President George H.W. Bush, whose undoing came about when he raised taxes after pledging not to, Clinton had to come up with a balanced approach that included targeted tax increases and reforms of social programs.
He was successful, in part, due to the demonization of “welfare queens,” a term that now evokes squeamishness, by President Reagan. In other words, as a Democrat he was able to reform the TANF benefit and be praised whereas President Reagan was called heartless.
If House Republicans put on their thinking caps, they too may find “welfare queens” in their constituencies. The possibilities have never been greater.
And no one will call them jerks.
Have a great rest of your weekend.
Emily Evans
Managing Director – Health Policy
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