The new, Republican-controlled Congress has made no secret of its intention to repeal some or all of the Affordable Care Act. But, writes Professor Charles Tiefer in a Forbes.com column, Congress is also preparing an “assault” on Medicare and Medicaid.
How will Congress carry out this assault? Via changes in House floor procedure, Tiefer says.
“What the House Republicans do on the first day” – Jan. 3 – “is not like a mere campaign speech or platform,” Tiefer says. “It is the actual set of procedural rules that govern what the House will do for the next two years.”
Until now, he says, Congress has “procedurally shielded” Medicare and Medicaid from slash-and-burn political machinations. The two “mandatory spending” programs have not needed to compete with “discretionary spending” programs such as defense and homeland security.
That will no longer be the case now that House Republicans are changing the rules, Tiefer says: “The goal is to switch such programs from ‘mandatory funding’ to ‘discretionary appropriations.’”
This way, Medicare and Medicaid can be “reshaped into weakened and shrunken forms,” Tiefer says.
The biggest step will be to reduce funding, which means states will receive less annual federal aid – and will have few or no federal rules about minimum coverage, he says.
GOP-controlled states will likely “embrace” their new power to slash Medicaid, Tiefer writes, while Democratic-controlled states that don’t slash the program will need to raise taxes just to keep Medicaid at its current level.
As for Medicare, Republican lawmakers intend to “voucherize” the program, Tiefer says.
“The change would particularly disfavor ‘older, sicker and poorer’ Medicare beneficiaries,” he writes. “They would now find that decent-quality insurance policies would [cost] much more than they could afford. They would have to buy inferior insurance policies with which they will be lucky to buy health care of even the lowest quality. Unqualified providers who spend minimal time currently on each Medicaid patient, known as ‘Medicaid mills,’ would now be ‘Medicare mills,’ too.”