Senate Democrats — Minus Key Players — Signal Opposition to Medicaid Overhaul

Senate Democrats announced they have enough votes to block a GOP effort to overhaul Medicaid, but the lack of support from several key players suggests that cuts to the health program for the poor could still be part of the negotiations over raising the debt limit.

Sen. John D. Rockefeller IV said that 41 Senate Democrats have signed letters to President Obama opposing drastic changes to Medicaid, including one that he sent with 36 others saying they would oppose federal caps on program spending.

Rockefeller, D-W.Va., said he hoped the Democrats’ coalition would help set terms for Medicaid in the ongoing debt ceiling negotiations.

“We’re counting on the White House to stand firm on our shared values here,” said Rockefeller. “Medicare and Social Security have been declared off the table in deficit negotiations, but Medicaid suddenly looks like the sacrificial lamb. I say absolutely no.”

Conspicuously absent from the letters were the signatures of several Democratic leaders, including Majority Leader Harry Reid of Nevada, Finance Chairman Max Baucus of Montana and Budget Chairman Kent Conrad of North Dakota. Aides did not immediately explain the members’ rationale, but the omission of the leaders’ names likely means they want to preserve their flexibility. It may also indicate they believe they may have to accept some changes to Medicaid — though likely less drastic ones than recommended in the House’s fiscal 2012 budget resolution (H Con Res 34).

That resolution proposes converting the federal share of Medicaid from an entitlement for certain low-income groups into a state block grant indexed to inflation and population growth. Republicans are demanding that changes to programs like Medicare and Medicaid be part of any final deal to raise the debt ceiling.

Irwin Redlener, president of the philanthropic group Children’s Health Fund, said that both parties should agree to cut services that are unnecessary, redundant or not cost-effective.

While he said he supports preserving Medicare and Medicaid, Redlener added, “I’m also a big believer in the fact that we’re without doubt overspending in both of those programs, because we’re paying for services that are not necessary and are very, very costly without having discernable health benefits.”

Republican governors, such as Haley Barbour of Mississippi, say the block grant proposal would control federal spending and give governors flexibility to tailor the program to their states’ needs. Democrats counter that it would hurt seniors, the disabled and the poor, and shift costs onto local communities.

Redlener, also a professor at the Columbia University Mailman School of Public Health, called the block grant proposal “short-term thinking in the extreme.”

“The consequences will be both very harmful and dangerous to individuals and ultimately have an undesirable economic impact as uninsured people flood emergency rooms,” he said.

A May poll from the Kaiser Family Foundation found that 60 percent of Americans want to keep Medicaid as is, while 13 percent favor major cuts to the program as part of efforts to reduce federal spending.

In addition to the Rockefeller letter, four Democratic senators have sent separate letters to President Obama opposing the block grant proposal for Medicaid: Dianne Feinstein of California, Amy Klobuchar of Minnesota, and Mark Udall and Michael Bennet of Colorado.

Feinstein’s letter indicated that she would be open to accepting other changes to Medicaid.

“Balancing the budget by dismantling the long-standing health care program for low-income Americans is not the answer,” Feinstein wrote. “Changes to programs that serve the most vulnerable must be made with the utmost care.”

In their letter, the Colorado Democrats asked Obama to preserve the “foundational integrity” of Medicaid.

“We share your commitment to finding a comprehensive solution to our deficits. The road toward that goal will not be easy — everyone must be wiling to give a little,” the senators wrote.