Medicaid Cuts Are the MAGA Suicide Pill

The impending agony of West Virginia

How much can the Trump Administration screw over its own base? Maybe a lot, though we can certainly hope otherwise. One gauge is the fate of the Medicaid program. A good place to watch is West Virginia, which is 15 minutes away from my home, though a world apart. Unlike Loudoun County, VA., WVA is one of the lowest-income states in the U.S. It went massively for Trump, while my county (wealthy, mostly white and Asian) and Virginia went marginally for Harris/Walz. If class consciousness in the old sense meant anything, in WVA they would be stringing Trump politicians up in uncomfortable ways.

As my friends at CEPR.NET report, over 72 million people get medical benefits from Medicaid. It’s focused on lower-income families, subject to a means test. In other words, your income has to be low enough for you to be eligible. It’s funny, in the shadow of potential cuts, we are not hearing much babble against the concept of means-testing, in contrast to prior years.

Medicaid is administered by state governments and partially funded through a Federal matching grant that is at least fifty percent. As I explained previously, the stealth method of cutting benefits is 1) pass a budget resolution requiring an obscure House committee to make massive cuts in the program, without mentioning exactly how, without even mentioning Medicaid; 2) force the committee to convert the matching grant into a “block grant” whose value is eroded by inflation; 3) force state governments to be the bad guys who reduce benefits and/or narrow eligibility to keep the program in operation at some level.

Another dodge is instituting a per capita cap on a state’s benefits. In either case, a block grant or cap, the extent to which medical inflation outpaces whatever inflation adjustment is put into a new bill, if any, that is the extent to which benefits must be cut. It need not happen immediately, certainly not before upcoming midterm elections. Since budget numbers are made according to ten-year projections, a change now that kicks in later can still be used as a source for savings devoted to tax cuts or terrorization of immigrants.

We will also be hearing nonsense about adding work requirements, so toddlers and grandmas in nursing homes, time to get out there and sell flowers or something. The truth is that work requirements, whatever their cruelty, are never able to generate much in the way of “savings.” I used quotes because any government saving here is the beneficiary’s dissaving, in the form of withheld medical care. That’s my kind of economics.

An overlooked fact about Medicaid, by which I mean overlooked on the Left, is that expansions are possible without the limitation of every other state following along. In other words, a benefit of federalism is that it escapes the national constraint limiting Medicare, or Medicare For All.

Of course that is also a limitation. The Feds can expand Medicaid without every state following along. The ObamaCare expansion was an example. Even the inception of Medicaid itself was not immediately taken up by every state. Nevertheless, federalism is hard-wired into the U.S. constitution and public sector. You can complain about it and imagine fantastic alternatives, but it isn’t going away any time soon.

So, what about West Virginia? Per CEPR.NET, a staggering 28.2 percent of its population are Medicaid beneficiaries. Another go-to source is West Virginia Watch. Still another is the West Virginia Center on Budget and Tax Policy. They are on the case. What about the nitwits WVA voters have sent to Congress and their state legislature? Alas and alack!

Senator Shelly Moore Capito is “concerned.” Shades of Maine Senator Susan Collins! I suppose she will be sending her constituents thoughts and prayers when they are denied medical care, or their local hospital is forced to shut down. Capito suggests that work requirements are plausible, as if that had anything to do with saving money,

Delegate Matthew Rohrbach (R-Cabell) asked how the state match would be affected under a block grant. Somebody should tell this nitwit that under a block grant, there is no freakin’ match.

As a poor state, WVA needs its Federal grant dollars, so it could also be hurt by cuts in grants for Low Income Energy Assistance and Temporary Assistance for Needy Families (TANF). Incidentally, in WVA the maximum cash benefit under TANF, a favorite topic of mine, is $542 a month. According to the state, there are 11,470 beneficiaries. Google says the state contains 287,600 in poverty in 2023. The West Virginia Center says half the state’s budget comes from Federal grants. Damn.

Without its support among lower-income folks, especially white people in rural areas, MAGA politics are dead in the water. Medicaid cuts are the MAGA suicide pill. Trump may not care, since he might not live long enough to suffer any inconvenience from a Democratic resurgence.

One shudders to think of the kid gloves with which a newly-triumphant Democratic Congress and president would handle a senile, babbling ex-president who wrecked the country and made the world a worse place. Remember Obama’s “We’re not looking backward, we’re looking forward.”