Health Bill Does Not ‘Cut’ Medicaid Spending, Republicans Argue – New York Times

The explanation, echoed by many Republicans who see the bill as their best chance to repeal the Affordable Care Act, has reignited a debate over what counts as a cut, in budget parlance. The distinction has become a central talking point for Republicans to rebut claims that they are promoting a bill that could send older people packing from nursing homes and cause children from low-income families to go without medical care.

The nuance is also an important one for Mr. Trump, who campaigned on a promise that “there will be no cuts” to Medicaid, Medicare and Social Security.

At issue is whether the funding changes should be compared to the increases that would occur under current law, the Affordable Care Act, or whether the focus should be on the modest annual increases that would happen under the Republican bill.

The White House says that Republicans are being victimized by a broken budgeting system that unfairly casts their fiscal restraint as callous cutting.

“Generally speaking, we spend more every single year on Medicaid,” Mick Mulvaney, the White House budget director, said in an interview this month. “We are not gutting or filleting or kicking people off those programs. We are trying to slow the rate of growth of government.”

Debates over how to characterize such funding changes frequently occur when Republicans embark on policies that would shift money away from entitlement programs. President Ronald Reagan faced similar arguments when he wanted to reduce government spending in 1984, as did President George W. Bush when he tried to overhaul Social Security in 2005.

“This has not been just semantics, but a political war for 40 years now,” said Douglas Holtz-Eakin, a conservative economist who led the Congressional Budget Office from 2003 to 2005.

Democrats have also not been immune. The Affordable Care Act slowed growth rates in the federal Medicare program, and Republicans made estimated $716 billion reductions a theme of 2012 election ads.

Mr. Holtz-Eakin said that he survived as the budget office’s director by avoiding using the word “cut” as much as possible because of its political connotation.

“In a political ad, the first thing you say is ‘cut,’” he said. “Then you go to the synonyms like ‘slash.’ Pretty soon it gets to be a real powerful attack.”

Democrats say that Republicans are twisting the numbers for their political purposes. Nominal dollar increases, Democrats argue, are meaningless if prices are rising.

In addition to the growth-rate changes that Republicans have defended and said are not cuts, the Senate health care bill would also reduce federal funding to states that have expanded their Medicaid programs to include poor adults as part of the Affordable Care Act.

“The question of whether it’s an increase or a cut is really about how people experience health care and whether people will be covered,” said David Kamin, a law professor at New York University and a former economic adviser to President Barack Obama. “From my perspective, it would best be described as a cut.”


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