One of the problems with the on-again, off-again GOP health-care strategy of “repeal and delay” is that it would overtly backload a lot of key policy decisions for mañana. But it is beginning to dawn on Republicans and Democrats alike that the Better Care Reconciliation Act of 2017 kicks some important cans down the road as well, especially with respect to Medicaid funding. And the more Mitch McConnell continues to shape BCRA by giving “moderates” short-term concessions on Medicaid while assuring conservatives long-term cuts in the program will please them, the more conservatives may be betting on a favorable political configuration that could vanish between now and then. Here’s how Politico explains the quandary:
The Senate bill, if passed into law, would certainly result in political pain — it would reduce federal Medicaid spending by $772 billion over 10 years, shifting to an even more frugal spending path over time. It would also for the first time cap, or limit, the federal contribution to Medicaid, starting in 2020. And it would unwind Obamacare’s Medicaid expansion.
It is expected that those cuts would create huge gaps in state budgets, and governors would have to make up the money somehow — or else drop people or trim benefits. Those pressures have Republicans openly speculating that a future Congress would face immense political pressure to block or delay the cuts.
Conservative health-policy wonk Philip Klein describes the backloading of cuts that will offset front-loaded concessions to “moderates” as sucker-bait:
Based on history and common sense, conservatives have every reason to place much more weight on the idea that the short-term spending is going to come through, and the promised spending cuts and reforms are very unlikely to ever be implemented.
This fear may be why Senate conservatives like Ted Cruz are now focusing on immediate steps Republicans could take to unravel (or let states unravel) Obamacare regulations, instead of being satisfied with the “entitlement reform” that long-term Medicaid cuts might represent.