Senate exterminators gear up to expel Medicaid expansion beneficiaries

Earlier this spring, we had a squirrel in our eaves. An exterminator installed a one-way door, leaving the squirrel free to rattle about until circumstances drove her outside. Which of course they did, after a few days -- maybe three, maybe seven.

Way back in mid-January, when the AHCA was just an exhalation from Paul Ryan's college memories, this promise from Texas Senator John Cornyn seemed startling and impressive:

When Cornyn was asked if he was concerned about people who’ve benefited from Medicaid expansion losing coverage, he said it was a shared concern.

“Were all concerned, but it ain’t going to happen,” Cornyn said. “Will you write that down… It ain’t gonna happen.”

Reporters followed up.

“You’re saying nobody’s going to lose coverage?” one asked.

“Nobody’s going to lose coverage,” Cornyn said. “Obviously, people covered today will continue to be covered.

Depends on what your definition of "lose" is. The AHCA maintains enhanced federal funding for Medicaid expansion enrollees who are enrolled before Jan. 1, 2020 -- as long as they maintain continuous coverage. But non-disabled non-elderly adults on Medicaid regularly churn in and out at fairly short intervals. With enhanced federal funding ending in 2020, CBO forecasts that just a third of then-current enrollees who gained coverage through the expansion will still be enrolled within two years, and just 5 percent by 2024.  Word has it today that the Senate bill will postpone the phase-out to 2023. Whatever the end date, the legislation ends the expansion. As of 2020, or 2023, or July 4 2021 or whatever, low income adults can churn out of Medicaid, but they can't churn in.

To explain the promise of this one-way door, Senator Rob Portman of Ohio got metaphysical:

I don’t want to pull the rug out from under anyone,but let’s not leave the rug out there for a couple more years to have more people stand on the rug.

Pulling a rug out from under people trips them up, but the rug itself does not support anyone. Portman manages to suggest a) that taking Medicaid away from the expansion populatoin causes harm, but not offering it  doesn't, and b) that further cutting the ranks of Ohio's uninsured, and providing Medicaid at need to working class people who may churn in and out is not worth the cost. Somehow, this metaphoric mashup evokes Paul Ryan's hammock, that sweet bed of federal benefits on perpetual offer to the undeserving poor.

Lord. what brutes these Republicans be. The moderates speak smoothly of smooth transitions, by which they mean killing the Medicaid expansion, and ultimately Medicaid as a whole through per capita caps, more slowly. However they spin it, they are determined to put the drive toward universal coverage into reverse.