Tag: Medicaid

First, this morning House Majority Leader Eric Cantor (R-VA) made the rounds of talk shows spouting how the Affordable Health Care bill can be repealed with a simple majority in the House and Senate since the bill was passed under reconciliation. Without a filibuster proof majority in the Senate, Ryan Lizza at The New Yorker points out the obstacles for that to happen:

Many Republicans, especially in the blog and talk-radio swamps, would cry, “Use reconciliation!” Readers familiar with the congressional debates of 2009-2010 will remember that this procedure allows certain budgetary measures to pass through the Senate with a simple majority. [..]

But reconciliation wouldn’t work here-the process can only be used for policies that have budgetary effects and a C.B.O. score. Much of the A.C.A., such as the insurance exchanges and subsidies, would fall under these categories. But a lot of it, including the hated individual mandate, does not. Repealing the exchanges and subsides without repealing the mandate and the other regulations and cost controls in the law would create a health-care Frankenstein that a President Romney would be rather nuts to support.

That said, the SCOTUS ruling has some rather complex ramifications and Chief Justice Robert’s ruling was rather sly. First was there are the three bit from SCOTUSblog that Lambert Strether pointed out at Corrente:

First, here’s the reasoning:

   Essentially, a majority of the Court has accepted the Administration’s backup argument that, as Roberts put it, “the mandate can be regarded as establishing a condition — not owning health insurance — that triggers a tax — the required payment to IRS.” Actually, this was the Administration’s second backup argument: first argument was Commerce Clause, second was Necessary and Proper Clause, and third was as a tax. The third argument won.

Second, here are the implications for the role of the State as we have understood it from the New Deal onward; what Phillip Bobbitt would call a change a Constitutional Order:

   The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws.

Third, here is the new Constitutional Order:

   Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy proposition.

Chancy or not — and it will be the precariat that suffers mischance, and not the elite, in any case — that’s what they’re going to do.

Next from Scarecrow at FDL News Desk who argues that Chief Justice Robert’s “incoherent decision” will “shackle congress” and “screw millions of uninsured:

In the process, he did violence to constitutional law and logic.  Consider, for example, Robert’s logic on the “mandate.”  In saving the “mandate,” Roberts essentially defined it as not a mandate.  You are not really required to purchase insurance, he noted; instead, you may choose not to purchase insurance and instead pay a minor tax.  As we know, taxing is just a way to collect revenues, a contribution to the common, aggregate costs of public programs.  In this case, the program is paying for many people’s health care through a system of risk/cost sharing.

But if the so-called mandate is not really a mandate but rather an option that can be avoided by paying a tax, and if a legitimate purpose of this tax, as government and amicus briefs argued, is to help cover aggregate costs across a pool of many insured and uninsured people, then what does that do to Robert’s argument about the Commerce Clause?  When arguing about the Commerce Clause, Roberts insists it’s a requirement to purchase a “product,” which forces you to take an action, and thus to engage in commerce when you would not otherwise have done that.  Regulating “inaction” is not permissible, Roberts argues.

But if, as Roberts concludes, the “mandate” is not a mandate, and the tax’s purpose is to help cover pooled costs, and not to buy a “product,” then there is no “mandate” to purchase a “product.”  So no one is forced to engage in commerce as Roberts framed it.  Indeed the “commerce” is already there in the risk sharing system across millions of people, all engaged in commerce by paying premiums into a pooled risk scheme.  Robert’s entire premise for striking down the Commerce Clause rationale is thus contradicted by his argument about how it’s permissible for Congress to enact a tax to support funding of collective health care costs.  That’s what the tax does; but it’s also what paying insurance premiums does.

Roberts’ reasoning on Medicaid is equally illogical. His premise is that Congress cannot expand an existing program administered by states that depends on shared state/federal funding by conditioning funding for the whole program on the states actually implementing the expansion.  As Brad DeLong observes, if Congress were just now creating a fully expanded Medicaid, to be implemented by states but mostly paid for by the feds, there would be no question that Congress could condition federal funding on the states actually carrying out the programs.  But if the program already exists for half the needy population, Congress cannot complete the program for the other half and use the same leverage to achieve the same degree of state cooperation.

As per the CBO, if the states actually implement the expansion and make an effort to get those eligible to sign up, 16 to 17 million more people will have health care coverage. But without that leverage to get the states to accept Medicaid expansion it leaves the poor between around 50% and 133% of the poverty line in a real no man’s land, because they would both be ineligible for Medicaid AND the coverage subsidies in the exchanges.

As for the states voluntarily opting in for the Medicaid expansion, David Dayen doesn’t think that will happen either, even though the cost for the states would only be responsible for less than 10% of the costs.

And being on the hook for even a small amount of funds isn’t going to make any of these governors happy. Heck, here’s a Democrat, former West Virginia Governor and current Senator Joe Manchin, making the argument for them:

   We should all recognize that the health care challenges that many West Virginians and Americans face are not going to go away unless Congress takes additional action to repair this bill. Now that the Court has ruled, we can move forward with fixing what is wrong with this bill and saving what is right. I have always been determined to reduce the burden on states from the Medicaid expansion, and this ruling affirms my position – and makes clear that states must have the flexibility to live within their means by determining Medicaid eligibility as each state sees fit. I have always said one size doesn’t fit all.

That’s going to be a compelling set of logic for a non-trivial number of governors. They’ll also distort how much the expansion would put their states “on the hook.” 26 states sued to eliminate the Affordable Care Act entirely, and they almost got there. Why wouldn’t they jump at the chance to eliminate the portion that creates half of the coverage benefits?

This isn’t going to be universal. New Mexico’s Republican Governor Susanna Martinez, for example, certainly sounds like she’ll take the money. But Southern states in particular, who paradoxically house the citizens most in need of the Medicaid expansion coverage, will be likely resisters at the outset. And it’s not like a lot of success in modern America comes from rallying at the grassroots level for poor and disenfranchised people.

As was noted by Ezra Klein of the Washington Post, opponents of the ACA see this as a win:

“We won,” said Georgetown law professor Randy Barnett, who was perhaps the most influential legal opponent of the Affordable Care Act. “All the arguments that the law professors said were frivolous were affirmed by a majority of the court today. A majority of the court endorsed our constitutional argument about the Commerce Clause and the Necessary and Proper Clause. Yet we end up with the opposite outcome. It’s just weird.”

Yes, it’s weird but so was the whole ACA bill from the very start.

The deadline for the bicameral Super Committee to come up with a deal on deficit reduction is a week away. While many American’s don’t think that the committee will meet the deadline thus triggering large mandated budget cuts to defense and entitlements, we have President Obama warning the committee not to “cheat” by changing the law so that those cuts, particularly to the Defense, would not go into effect should the committee fail. Meanwhile, the committee’s Democratic members are proposing a $2.3 trillion tax-and-cut proposal “that includes $400 billion in Medicare and Medicaid reductions,” but only if Republicans compromise by putting new tax revenues on the table that in the end would only amount to $350 billion in new tax revenue.

The other really unacceptable proposal that the Democrats have put on the table to get the Republicans to agree to a paltry $350 billion in tax revenues, is making the Bush/Obama tax cuts permanent, even though the White House has said that President Obama would veto any bill that made those cuts permanent. Perhaps they are counting on Obama doing his usual last minute capitulation and he would sign the bill.

The Democrats are scrambling to try to make this look like a good deal but it’s not. Letting the Bush/Obama tax cuts expire would solve more of the deficit problem than anything that this committee or Congress has proposed by increasing tax revenues $1 trillion over the next 10 years. To their credit though, the Democrats have rejected the Republican offer that would cut all the tax rates across the board by 20%, lowering the top tax bracket to 27% from 35% assuming the Bush tax cuts would be extended. This would reduce tax revenues by $200 billion in just one year.

This is a muddled mess that is not really a crisis at all and in the long run won’t create any jobs but deepen the economic crisis that has been created by the burst of the housing bubble, job killing foreign trade agreements, unfair tax codes and the lack of banking regulation.

John Aravosis at AMERICAblog nails what has exacerbated much of problem: the Democrats negotiating techniques, or rather, the lack of them. The Republicans negotiate while the Democrats come to the table and offer their bottom line, so there is nowhere to go but to cave to Republican demands:

Note how the Republicans are still skewing their proposals towards large budget cuts and little tax increases, whereas the Democrats are offering 50-50 budget cuts and tax increases. That means that if both parties make concessions as they move to the “middle” – which is highly unlikely, the Dems will cave while the Rs will stay put – the “middle” will be a point at which there are more budget cuts than tax increases. Why? Because the Democrats, as always, are making their final offer – half tax increases, half budget cuts – first, so there’s nowhere to go but down.

This had been the Democratic approach since 2006 when the party gained control of both houses of Congress. It’s no wonder that voters are disgusted with both parties and that the Democrats lost the House in 2010. By gutting our social safety networks to protect the wealthy and appease the Republicans, the Democrats could well lose more in 2012 if they don’t start listening to the demands of the American people.

h/t to DCblogger at Corrente

In his speech Monday, President Barrack Obama actually started to sound like a president. His threat to veto any deficit cutting legislation that did not include revenue producing tax increases was praised by everyone left of Attila the Hun as “progressive”. It gave these critics some kind of new “hope” that Obama had finally drawn a line in the sand with the “my way or the highway” tea party Republicans.

Really? Were any of them listening to what he did say? What did most everyone from Michael Moore on Rachel Maddow’s show to Markos Moulitsas and Move-On.org miss? Anyone with half a functioning brain can see that what Obama offered was just more of the same insanity, piled higher and deeper that and was being covered with his new found veto power.

What should have caught their attention was what Jon Walker at FireDogLake pointed out:

In fact,  in his only veto threat Obama made it clear he would accept Medicare benefit cuts if they were accompanied by new tax revenue from the rich by saying, “I will veto any bill that changes benefits for those who rely on Medicare but does not raise serious revenues by asking the wealthiest Americans and biggest corporations to pay their fair share.” That “but” is a very important clause that means there are scenarios in which Obama would sign a bill that significantly cuts Medicare benefits.

Hello? Did anyone besides a very few of us on the left not hear this?

Obama’s communications director, Dan Pfeiffer said, “we are entering a new phase.” And just what “phase” would that be? “Chief Negotiator” to “Chief Hostage Taker” to get his right wing Republican agenda past this extremist congress?

Obama is now using the social safety network that protects our most vulnerable citizens to con the electorate that he has changed and to reelect him.

What bilge.

Yes, the Republicans are partly correct in saying that the President’s newest proposal to increase revenues by adjusting the tax rates on top earners to make sure they pay their fair share is class warfare:

WASHINGTON –  Republicans on Sunday decried the notion of a new minimum tax rate for millionaires as “class warfare,” saying the proposal by President Obama may be intended to portray Congressional Republicans who resist it as being callously indifferent to the hardships facing many Americans.

They just have the wrong class on whom that war has been declared:

WASHINGTON – President Obama on Monday will call for a new minimum tax rate for individuals making more than $1 million a year to ensure that they pay at least the same percentage of their earnings as middle-income taxpayers, according to administration officials.

With a special joint Congressional committee starting work to reach a bipartisan budget deal by late November, the proposal adds a new and populist feature to Mr. Obama’s effort to raise the political pressure on Republicans to agree to higher revenues from the wealthy in return for Democrats’ support of future cuts from Medicare and Medicaid.

Mr. Obama, in a bit of political salesmanship, will call his proposal the “Buffett Rule,” in a reference to Warren E. Buffett, the billionaire investor who has complained repeatedly that the richest Americans generally pay a smaller share of their income in federal taxes than do middle-income workers, because investment gains are taxed at a lower rate than wages.

Mr. Obama will not specify a rate or other details, and it is unclear how much revenue his plan would raise. But his idea of a millionaires’ minimum tax will be prominent in the broad plan for long-term deficit reduction that he will outline at the White House on Monday.

Sure, Obama may look like he’s being more “confrontational” with Republicans but the reality is he is still selling out the most vulnerable of our citizens.

So now we’ve heard Barry’s big “jobs speech” and it turns out to be the exact opposite of what is needed to rescue the crumbling nation.  No surprise there.

Obama’s so-called “jobs plan” is huge cuts in the payroll tax that are designed to manufacture a real future shortfall in Social Security, Medicare, and Medicaid, which will then be used as the rationale for imposing deep cuts on, or even the elimination of, all three programs.  Corporate tax cuts will drain even more revenue from the treasury, which will make extending unemployment insurance for the unemployed who currently qualify, not to mention infrastructure repair, highly unlikely.

This article was authored by our neoliberal Democratic saviors on the new and improved Cat Food Committee (h/t digby). We are so screwed:

Together We Can Beat the Deficit

By PATTY MURRAY, MAX BAUCUS AND JOHN KERRY

Our country has long been a beacon of light in the world because the American people always come together when times are tough. Over the past few months, in debating the debt ceiling and deficit reduction, that light of common cause has appeared to flicker at times in our nation’s capital. As appointees to the Joint Select Committee on Deficit Reduction-12 members of Congress charged with finding $1.5 trillion in deficit reduction over the next decade-we hope to remedy that.

snip

   Make no mistake, this is an important moment for our country. Millions of Americans are still hurting, working overtime to pay the bills, struggling to find a job and a way forward for their families. Trillions of dollars in private capital are sitting on the sidelines because businesses are not yet confident enough in our economy or in their lawmakers to invest in the future. These families and businesses are demanding that this new committee work together to overcome the partisanship and brinksmanship of recent months and put our fiscal house in order.

   The Standard & Poor’s downgrade of America’s credit rating was an unprecedented wake-up call for those who have for too long acted as if overheated rhetoric and dysfunction in Washington has no consequences for Main Street and working families. The shockwaves that roiled financial markets after the downgrade was a condemnation of Congress’s inability to address the unsustainable trajectory of our current fiscal policies.

snip

   None of us ran for office arguing that the United States should see its credit rating downgraded. Nobody ever campaigned in favor of mountains of debt or championed the idea that every American’s interest rates should go up. And no one has ever gone into a debate pledging that China and India should own this economic century because we can’t make our democracy work here at home.

   This moment demands leadership, but it also demands consensus. The Joint Select Committee on Deficit Reduction was set up to require bipartisanship, and we are going to work hard to achieve it. We know that each of us comes into this committee with clear ideas on the issues and what our priorities are for our nation. But a solution can only be found by merging these priorities across party lines and finding a solution that works for the American people.

   We know that our goal is to reduce spending. But we also know that America faces not just a budget deficit but also a jobs deficit. Nobody on this committee would be happy if we reduced the budget deficit but even more Americans end up losing their jobs.

   So we are ready to get to work with our colleagues on both sides of the aisle to report out a balanced plan, with the shared sacrifices this moment requires. One that moves past the partisan rancor, puts our nation back on strong fiscal footing, and allows us to continue shining bright in the world in this generation and for generations to come.

Like digby said: “Confidence Fairy, “shared sacrifice”, “balanced approach”, China bashing, the whole nine yards.”

Then there is Obama’s less than inspiring not a plan yet and the Chamber of Commerce clamoring for “for “reform of entitlement programs” like Medicare and Medicaid (which means cutting spending on these programs).”

The stocks of the maker of Preparation H may just save the tanking stock market  

Catfood is made out of peas? Who knew? lambert

This press conference tells us that the austerity crap isn’t some bit of political posturing, it’s a belief. We’re doomed. Atrios

The right wing Republican talking points that were spewed by President Obama at his press conference were so thick that it has left no doubt the president is about to sell out the middle class and poor.

President Obama said Monday that he had “bent over backwards” to forge a compromise with Republicans on a debt limit deal – and that it was time for them to “budge.”

“I am prepared to take on significant heat from my Party to get something done and I expect the other side to be willing to do the same thing,” he said. . . . .

“We have to pull off the Band-aid — to eat our peas,” he said.

I don’t often agree with NYT Columnist Russ Douthat but his analysis of the “madness” cuts to the point:

Barack Obama wants a right-leaning deficit deal.  

The not-so-secret secret is that the White House has given ground on purpose. Just as Republicans want to use the debt ceiling to make the president live with bigger spending cuts than he would otherwise support, Obama’s political team wants to use the leverage provided by those cra-a-a-zy Tea Partiers to make Democrats live with bigger spending cuts than they normally would support. . . .

Why? Because the more conservative-seeming the final deal, the better for the president’s re-election effort. In that environment, Republicans have every incentive to push and keep pushing. Since any deal they cut will be used as an election-year prop in 2012, they need to make sure the president actually earns his budget-cutting bona fides.

The problem is that voters don’t care about the deficit. They care about jobs and the economy. Spending cuts, tax cuts and austerity programs do ot create jobs. Even Ronald Reagan’s budget director, David Stockman, now admits that Reaganomics and the Bush tax cuts are a major cause of the current “debt crisis” and takes Obama and Rep. Paul Ryan to the “woodshed”

“In attacking the Bush tax cuts for the top 2 percent of taxpayers, the president is only incidentally addressing the deficit,” he writes. “Mr. Obama is thus playing the class-war card more aggressively than any Democrat since Franklin D. Roosevelt – surpassing Harry S. Truman or John F. Kennedy when they attacked big business or Lyndon B. Johnson or Jimmy Carter when they posed as champions of the little guy.”

“On the other side,” he continues, “Representative Ryan fails to recognize that we are not in an era of old-time enterprise capitalism in which the gospel of low tax rates and incentives to create wealth might have had relevance.”

Eat your peas, we are doomed.

After the big Republican pow wow with the president at the White House, the so-called liberally biased media turned their mikes over to the Republicans so they could spout more lies about Paul Ryan’s budget, Medicare and the economy. One of the bigger lies about Medicare was a recycled one about Medicare from that little pouty demagog, Paul Ryan:

Millions of dollars of negative ads are being run to try and scare seniors and trying to confuse seniors. You know, the irony of this Bill, is with all this Mediscare that the Democrats are running, it’s Obamacare itself that ends Medicare as we know it. Obamacare takes half a trillion dollars from Medicare – not to make it more solvent but to spend on this other government program, Obamacare. And then it creates this 15 panel board of unelected, unaccountable, bureaucrats starting next year to price control and ration Medicare for current seniors.

Just how many times to we have to debunk this lie?

From Think Progress:  

The ACA reduced annual increases in payments to hospitals, skilled nursing facilities, home health agencies, and other institutions to spur productivity and cut overpayments to private insurers that are not delivering value for Medicare dollars. It used that money to expand coverage to 32 million Americans – many of whom were receiving uncompensated care at these institutions – to extend the life of the Medicare program and invest in new demonstration projects that aim to encourage providers to deliver quality care more efficiently. Seniors’ guaranteed benefits are in no way affected.

The “15 panel board,” as Ryan calls it, is actually the Independent Payment Advisory Board (IPAB). It will include individuals from across the health care field, all of whom will have to be confirmed by the Senate. Significantly, their proposal to reduce spending cannot “include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums…increase Medicare beneficiary cost- sharing (including deductibles, coinsurance, and co- payments), or otherwise restrict benefits or modify eligibility criteria” (Section 3403 (page 409) of the Affordable Care Act stipulates.)

The Democrats need to tell the White House and the democratic leadership to take Medicare off the budget deficit negotiating table now. As Greg Sargent observes recent polling shows Americans are strongly opposed to cutting Medicare. If the Democrats agree to cuts it will doom there electoral advantage in 2012.

If Democrats in deficit negotiations agree to a compromise that cuts Medicare benefits to seniors, they risk squandering the advantage they’ve built up over Republicans on the issue since 2010 and risk losing their more general edge as defenders of the middle class, a top Dem pollster who just completed an extensive health care poll tells me.

Jeff Liszt, of the respected Dem firm Anzalone Liszt, has just completed a poll for two liberal-leaning groups finding that the Paul Ryan Medicare plan is deeply unpopular with voters, and particularly with seniors and independents, when the plan is described to them. The poll also found that Obama and Dems have increased their advantage over Republicans on Medicare, on health care in general, and on who can be trusted to defend the middle class.

After spouting off before the cameras, the house went back into session, and using a twisted rules maneuver attached the rejected Ryan budget onto the Homeland Security Appropriations bill in a ‘deem and pass’ move. From Nancy Pelosi:

   Despite Americans soundly rejecting the Republican budget to end Medicare-with a new CNN poll out today finding 58% oppose and opposition from senior citizens even higher at 74%-House Republicans doubled down on ending Medicare by passing a Rule on the Homeland Security Appropriations bill (pdf) which “deems” that the Republican budget is passed:

       Provides that H. Con. Res. 34, including the related 302(a) allocations printed in the Rules Committee report accompanying the resolution, shall have force and effect until a conference report on the concurrent resolution on the budget for fiscal year 2012 is adopted.

   House Democrats unanimously opposed the Rule today and the Republican budget ending Medicare which increases costs by $6,000 a year for seniors, cuts benefits immediately, and puts insurance companies in charge.

Because we aren’t going to let you get out from under it….

Thus spoke Anthony Weiner on on May 24th, laying out the Republican plan to replace Medicare with an inadequate voucher program:

Today, House Republicans brought another bill (HR 1216) to the House floor that does not address jobs and wastes time in a futile attempt to repeal part of the Affordable Care Act. House Democrats are staging a “mini-filibuster” by “striking the last word” allowing them five minutes of time to discuss their strong opposition to the Republican-passed budget which ends Medicare as we know it and forces seniors to pay over $6,000 more a year.

   Weiner: I move to strike the last word Mr. Chairman. Mr. Chairman, you may recall I was standing here approximately two hours ago waiting to speak with several other members on the efforts of my Republican friends to eliminate Medicare as we know it and for reasons that are known only to the Chair, I was denied the ability to do that. Well, I’m back. And just to review the bidding, here’s where it was before that order was made. We had the Chairman of the Republican Congressional Campaign Committee, a good man, a guy I like, stand down in the well and say, ‘Oh, no’ (and this by the way is someone who is elected by the Republican members to represent them in races all around the country) saying that the Ryan plan wasn’t a plan it was and I’m quoting here, “a construct to develop a plan” and he said the proposal is not a voucher program and then he said it was a one size fits all, that Medicare was draining our economy is what he said.

  Well, ladies and gentlemen, that might be the rationale for our Republican friends wanting to eliminate Medicare, but none of those things are true. It is not a ‘construct to develop a plan’ it is the proposal of the Republican party of the United States of America to eliminate Medicare as a guaranteed entitlement. If you don’t believe me, go get the book that they wrote, go get the budget that they wrote, go get the bill that they wrote.

h/t to Crooks & Liars for the transcript.

The Ryan Budget plan has failed in the Senate with 5 Republicans opposing it, the Republicans are still embracing the proposal to eliminate Medicare. They are in denial about the loss of NY-26, long a Republican stronghold. to Democrat Kathy Hochul. The sadder part is the White House has also missed the message

Joe Biden group to tackle Medicare and Medicaid: aide

Vice President Joe Biden and top lawmakers will examine government-run health plans on Tuesday as they try to work out a deal to raise the United States’ borrowing authority, a congressional aide said.

h/t Marcy Wheeler

It would appear that the White House is willing to sell out future seniors to give political cover for raising the debt ceiling.

When the Republicans voted lock step on the Ryan Budget plan that would decimate the safety nets of Medicaid ans Medicare, they were not prepared for the harsh criticism from their own supporters and organizations that had praised their agenda in the past. During the Spring recess, House members faced angry constituents and a harsh press. On Tuesday, 42 freshmen sent a letter to the president asking that the Democrats forget that they used Medicare scare tactics fighting the Health Care Reform bill and back off holding them responsible for their votes on the Ryan Budget bill. Sorry, guys, no do-overs. You own it now.

Republican Budget Would Cause Millions of Americans to Lose Medicaid

By Jon Walker @ FDL

The House Republican budget written by Paul Ryan has received a huge amount of criticism for its plan to replace Medicare with a poorly indexed private voucher program that could result in more and more seniors every year being unable to afford health care. Less focus has been put on how equally devastating the Ryan plan would be to people who rely on Medicaid because the plan would stop federal funding for the program from keeping up with the increasing cost of actually providing people with care.

A study from be the Kaiser Commission on Medicaid(PDF) lays out three likely scenarios of what would happen if the Republican plan were implemented.

Critics Fear G.O.P.’s Proposed Medicaid Changes Could Cut Coverage for the Aged

By Jennifer Steinhauer @ NYT

While the largest number of Medicaid recipients are low-income children and adults, who tend to be far less politically potent voices in battles over entitlement programs than older voters, the changes to Medicaid proposed by Representative Paul D. Ryan of Wisconsin, the House budget chairman, could actually have a more direct impact on older Americans than the Medicare part of his plan.

The House plan would turn Medicaid, which provides health coverage for the poor through a combination of federal and state money, into a block grant program for states. The federal government would give lump sums to states, which in turn would be given more flexibility and independence over use of the money, though the plan does not spell out what the federal requirements would be.

Beginning in 2013, these grants would increase annually at the rate of inflation, with adjustments for population growth, a rate far below that of inflation for health care costs. As a result, states, which have said that they cannot afford to keep up with the program’s costs, are likely to scale back coverage. Such a reduction, critics fear, could have a disproportionate effect on Medicaid spending for nursing home care for the elderly or disabled.

Critical Letter by Catholics Cites Boehner on Policies

By Laurie Goodstein @ NYT

More than 75 professors at Catholic University and other prominent Catholic colleges have written a pointed letter to Mr. Boehner saying that the Republican-supported budget he shepherded through the House will hurt the poor, the elderly and the vulnerable, and that he therefore has failed to uphold basic Catholic moral teachings.

“Mr. Speaker, your voting record is at variance from one of the church’s most ancient moral teachings,” the letter says. “From the apostles to the present, the magisterium of the church has insisted that those in power are morally obliged to preference the needs of the poor. Your record in support of legislation to address the desperate needs of the poor is among the worst in Congress. This fundamental concern should have great urgency for Catholic policy makers. Yet, even now, you work in opposition to it.”

The letter writers criticize Mr. Boehner’s support for a budget that cut financing for Medicare, Medicaid and the Women, Infants and Children nutrition program, while granting tax cuts to the wealthy and corporations. They call such policies “anti-life,” a particularly biting reference because the phrase is usually applied to politicians and others who support the right to abortion.

The shoe is once again on the other foot and it is up to the Democrats to make sure it causes permanent bunions, by making them own their votes and pay the price.