Too Quick to Pronounce Trump Budget Dead on Arrival

June 8, 2017

I recently said I was torn between delving into Trump’s proposed budget and picking at less-reported angles because the package was DOA in the Senate.

The Center on Budget and Policy Priorities says no such thing. Some Republicans may balk at some details, but the major thrusts replicate those in budgets the House has passed ever since Republicans gained control in 2010.

These include repeal of the Affordable Care Act (natch), block granting Medicaid and SNAP (the food stamp program) and a range of cuts to non-defense programs that depend on annual appropriations.

We’ve also seen, though CBPP doesn’t mention them, proposals to bar workers without Social Security numbers, i.e., not officially authorized to work for pay, from claiming the refundable Child Tax Credit, even though most of the children who’d benefit are U.S. citizens.

And let’s not forget tax cuts tilted heavily toward very rich people and thriving corporations — revenues the government could otherwise use to shore up programs that serve low-income people’s immediate needs and as both parties are fond of saying, build (or rebuild) the middle class.

What this means is that we could see a joint budget resolution that delivers program-slashing instructions to the committees that initiate definitions of what programs in their area can and can’t do and the maximum agencies can spend on them.

If the House and Senate can then agree on a resolution, the actual spending and/or tax cuts need only a majority vote in the Senate. So Democrats don’t have their usual chance to block bills they object to.

More U.S. Government 101 than perhaps any of you need. What matters more here is legislative strategy — not, one notes, an expertise our President brought to the White House or seems to be learning. But he’s got some high-level officials who have it.

Basically, when House and Senate leaders begin with a proposed budget as extreme as Trump’s, it sets the point from which they move toward the center, which may still be far from a true center that would satisfy, if not altogether please both Republicans and Democrats.

We’re still a long way from a budget for next year. But we’re not that far from the day when Congress must let the Treasury Department borrow more funds so that government can pay what it already owes.

The far-far right House Freedom Caucus says it won’t vote for any debt ceiling increase unless it’s packaged with spending cuts. The “leverage point” one member refers to is more than an idle threat.

The House Republican majority used it six years ago to force agreement on the across-the-board spending cuts and subsequent caps that will automatically kick in again if Congress and the President don’t agree to eliminate them or at least ease their blow.

What’s now called sequestration has already squeezed a range of programs that meet critical needs, including services and supports for low-income people.

Real dollar losses alone leave them with 13% less, CBPP reports. Factor in population growth — a likely measure of increasing needs — and losses rise to 18%.

Only so much blood you can squeeze out of a turnip. And the turnips we’re talking about didn’t have much, if any extra to squeeze.

Best hopes, I suppose, are Congressional Republicans who’ll support their state and/or local economies, e.g., farm state representatives, who know how SNAP increases demand. Also, of course, Democrats.

Their leaders have made very clear that they’ll not support a debt limit increase conditioned on tax cuts for the rich. Beyond that, the scene’s still murky.

Some recent reports suggest that Democrats may put other conditions on the bargaining table, rather than insisting on a “clean bill,” which Trump’s Treasury Secretary wants, but not, it seems, his Office of Management and Budget Director.

As if their boss didn’t generate enough turmoil in enough policy-relevant areas.

I’d like to end with something we progressives can do to push back against threats to even more programs than I’ve cited , e.g. Social Security Disability Insurance.

We surely can make our views known to our elected representatives — unless, of course, if we’re disenfranchised residents of the District of Columbia. We can donate to advocacy organizations, if we can afford to, join their social media campaigns, etc.

Obviously looking here for an antidote against a sense of powerlessness.

Well, I sez to myself, you recall the early days of the Reagan administration — how it tried to roll nearly 90 programs into five maxi-block grants, paired with a 25% funding cut and how much less bad things turned out in the version Congress approved.

Advocacy organizations formed issue-specific and linked coalitions. They, including those I participated in, shared information, developed strategies, lobbied and testified. I’m confident we made a difference.


Broken Bone, But Not Broke, Thanks to Medicare

December 1, 2016

A week before Thanksgiving, I got up on the right side of bed, but from closer to the edge than I realized. Landed flat on my back and lay there in excruciating pain. But I managed to get dressed, make sure essentials were in my purse, call 911 and hobble downstairs to open the door.

Folks in the ER took X rays and a CAT scan. Determined I’d fractured a pelvic bone, but probably wouldn’t need surgery. So they sent me to a hospital, where the tests were repeated and the same diagnosis made.

Then on to a rehabilitation center, where I got both physical and occupational therapy to ready me for living at home alone and as much painkiller they’d allow. I’m still in pain, but otherwise in pretty good shape—and home again neither permanently disabled nor bankrupt..

I’m told that the transport, medical and therapy services and the rooms, food and the like in the hospital and rehab center will cost me nothing. The painkillers require copay, but it’s small. And my Medicare Advantage plan sets a low cap on all my out-of-pockets for the year.

I shudder to think of the bills I’d face if not enrolled in Medicare — or more precisely, the Advantage plan I chose. And I says to myself, what if I were twenty or so years younger now and I’d had the same accident when I was sixty-five?

You know, I’m sure, that this isn’t a hypothetical question. House Speaker Paul Ryan apparently plans to link his pet Medicare “reforms” to whatever the Republican majority does to dismantle the Affordable Care Act,

“Medicare has got some serious problems because of Obamacare,” he recently told Fox News, claiming, as he has in the past, that the program “is going broke.” This is wrong on both counts, as the Washington Post’s fact checker explains. And Ryan probably knows it.

But he also knows he’s got an opportunity he didn’t before. He’s produced multiple versions of his so-called Medicare reform plan. The latest, in his Better Way healthcare policy paper, is a dense, blame-heavy thing. This much, however, I think, we can gather in answer to my what-if question.

I wouldn’t have health insurance through any form of Medicare. Ryan would link the minimum eligibility age to the age former workers become eligible for full Social Security retirement benefits. That would be sixty-seven under current law. But Ryan, among others, has wanted to raise it further.

The rationale for withholding both sorts of benefits from people who’ve reached what we ordinarily think of as retirement age is that Americans are living longer. This, Ryan says, is because we’re healthier—thus, inferentially, not in need of Medicare until we’re significantly older.

Set aside the over-simple reading of the rising longevity figure, we’re not living longer because we’re healthier. It’s rather because medical science has gotten better at keeping sick people alive and because we’re spending more on healthcare—this according to the National Bureau of Economic Research.

The constantly evolving treatments of various sorts will mean nothing, of course, if people who need them don’t have insurance to cover most, if not all of the costs.

And what about a case like mine? My life expectancy had nothing whatever to do with my falling, though my age may have had something to do with the fact that a bone cracked.

Say, however, I’d reached the ripe old age for Medicare. It wouldn’t come close to covering my healthcare costs. I’d get a subsidy of some sort to help me pay premiums for either a non-government insurance plan, misleadingly termed an Advantage Plan, or traditional Medicare, also misleadingly termed.

Ryan misleads because neither of the choices we’d have would offer as much care for as relatively little. Our premium support would do more for the poor than the well-off. But it wouldn’t rise to keep pace with rising healthcare costs.

This is a main feature, not a bug. Ryan’s fundamental aim isn’t to save Medicare, as he claims, but to cut federal spending. So the subsidy—not, he protests, a voucher—would cover less and less over time.

But we’d get more bang for the buck, he says, because insurers would reduce costs and improve quality of care so we’d choose their program over competitors’. Medicare would then have a built-in cost containment mechanism, as it doesn’t now.

It already has various price controls, however, though Republicans would blow some away in repealing the ACA.

The bigger deal, however, is that private insurers can’t keep premium costs and out-of-pockets low enough for most of us to afford them. Nor can what’s now traditional Medicare, which would be in even worse shape than its alternatives.

And the bigger deal yet is that the soon-to-be Secretary of Health and Human Services has long objected to Medicare and enthusiastically supported Ryan’s privatization plan.

Shortly before his nomination, he said he expected Congress to move forward with a Medicare replacement plan in six to eight months—as soon as it’s dispatched with the ACA.

Republicans can tackle both without any Senate Democrats voting in favor, through a somewhat arcane process known as budget reconciliation. So unless more than two Republicans heed the vast majority of Americans, who oppose any spending cuts to Medicare, future seniors won’t have affordable health care.

This tally assumes that Trump will ignore his promise to leave Medicare alone. We still don’t have a clear read on that. But I’m even less confident now than I was a couple of weeks ago. One need only look at the healthcare reform page on his new website—and, of course, his choice for HHS.

The fact that I personally got—and will continue to get—the healthcare services I need at a price I can afford doesn’t make what seems to be coming down the pike irrelevant to me, though that’s clearly what the Medicare reform crew intends.

Nor do I rest easy, knowing that ending Medicare as we know it is only one piece of the attack on our affordable healthcare system.

We know, for example, that block granting Medicaid appeals to Trump—and that he’ll almost surely have a chance to sign a bill that denies low-income people, seniors among them, the affordable healthcare services they can count on now.

This wouldn’t directly affect me. But if I had less money, it would because Medicaid would help pay for my Medicare out-of-pockets—and, in at least some states, the costs of a home health aide. Anyone hobbling around the way I am needs someone to help with basic tasks.

But how many states would still provide it as healthcare costs rise and federal funding doesn’t?


Congressman Ryan Defends His Radical Budget Plan

July 15, 2011

Recently listened in on a telephone interview with Congressman Paul Ryan, architect of the House of Representatives’ Fiscal Year 2012 budget plan.

One never knows, of course. But I’m inclined to believe that Ryan genuinely believes what he says.

In any event, we need to take what he says seriously because it shows how the Republican leadership wants to refashion social policy — and how it will justify the changes.

So here, in a nutshell, is what Ryan had to say about safety net programs and my comments thereon.

The House plan saves the safety net. This is Ryan’s over-arching argument. Our nation faces a fiscal crisis, he says. If we don’t address it, we’ll have to make drastic austerity cuts like what we’re seeing in Greece.

The House plan makes “gradual, sensible reforms.” They avert “real pain” because the alternative will be “cutting everyone indiscriminately.”

In other words, cuts to safety net programs are inevitable. We can opt to phase them in now or be forced to make them in one fell swoop later.

The former is better because only across-the-board cuts are painful. Why targeted cuts aren’t painful to the people they affect is a mystery.

Unsaid, but clearly implied is the notion that the federal government can’t afford to sustain safety net programs as they’re designed today. This should not be surprising since Ryan rules out any deficit reduction plan that involves raising more tax revenues.

Also unsaid, but clearly implied is the notion that safety net programs are a major factor in the upward-trending deficit. Not, so far as I know, a conclusion the data will support.

Experts of all political stripes are concerned about the rising costs of health care. These, of course, affect federally-subsidized health insurance programs, but the programs aren’t the driver.

Safety net programs help too many people. Ryan says we need to focus safety net programs on people who need help the most — and away from those who need it least.

In other words, eligibility standards for safety net programs should be made more restrictive. They’re now including people who should be left to cope on their own.

Ryan doesn’t say what the standard of need should be. One has to assume that it would be well below the federal poverty line to yield the kinds of savings he seems to feel are needed.

We’d then live in a society that accepts hunger, homelessness, untreated illnesses, etc. as just sad facts of life — something we can’t collectively do much about because it’s more important to have lower top tax rates.

Temporary Assistance for Needy Families should be the model for all safety net programs. All “welfare” programs, it seems, should be time-limited. Their reason for being is to “get people back on their own two feet.” Too frequently they become “a web that entraps people into a life of dependency.”

I’ve animadverted before about House Republicans’ seeming romance with TANF.

More generally, the notion that safety net programs undermine initiative, hard work and the like is becoming a virtual truism — and not among Republicans only.

Here in the District of Columbia, for example, our dyed-in-the-wool Democratic mayor, among others, has used it to justify time-limiting TANF benefits.

What’s striking to me is the assumption that people who need public benefits are, without exception, just down on their luck. They can all, with some training and other services, become entirely self-sufficient.

I can’t help thinking that Ryan and his ilk don’t know much about people who receive public benefits. Many of them, after all, are working but can’t earn enough to full support themselves and their families.

That takes a lot of money these days — even in places that aren’t as high cost as, say, the D.C. metro area, where a parent with two kids would need at least $63,430 a year just to pay for basic living costs.

Many low-income people face what experts tactfully term “employment barriers” — severe intellectual and/or physical disabilities, debilitating mental and/or physical illnesses, dependents with same, functional illiteracy, criminal records, etc.

It’s surely right and proper to do all we can to help these people get into the workforce. But adopting a system that will leave them entirely dependent on their earnings — no subsidized child care or health insurance, no housing vouchers, no nothing?

Communities should be free to have whatever sort of safety net they want. Ryan claims that Washington has denied communities “flexibility” and opportunities for “innovation.” This is the other face of his aim to extend the TANF model to other safety net programs.

In point of fact, state and local policymakers seem to have considerable flexibility now when it comes to outreach innovations, service delivery models, program administration and, even to some extent, benefits.

Anyone who thinks the federal government should get out of the standards-setting business altogether should take a look at how states are using the flexibility they’re afforded under TANF.

I, for one, would rather see Washington “lull creativity” than see any state limit safety net programs to 24 months and/or to households at 14% of the federal poverty line.

UPDATE: After I posted this, I learned that the interview is now online. You can listen to it or download the transcript here. Caution, however. The transcript is not 100% accurate.


Big Myths Used To Sell Food Stamp Block Grant

May 12, 2011

I might feel better about the House Republicans’ food stamp block grant if Congressman Paul Ryan, who wrote it, were up front about the motive. Not more supportive, mind you, but less concerned — and angry.

It’s clear that the food stamp block grant, like the Medicaid block grant, aims to slash federal safety net spending. Savings on food stamp benefits, plus state administrative support would total nearly 20% over the first 10 years.

The objective here is to pare back what we’ve come to view as our government’s mission — and to offset the revenues that will be lost by the proposed tax cut extensions and expansions.

But the budget plan doesn’t justify the food stamp program that way. It relies instead of three big myths.

The first is that the safety net is likely to become — if it hasn’t already — a “comfortable hammock that lulls able-bodied citizens into lives of complacency.”

Complacency? Ryan and his colleagues obviously haven’t taken a food stamp challenge recently — or tried to support themselves and their families on an income well below the federal poverty line.

The second myth is that participation in the food stamp program is increasing at a “relentless and unsustainable” rate because states get more federal funds when they enroll people.

But, as the Center on Budget and Policy Priorities shows, the recession accounts for most of the recent uptick in food stamp spending. Costs, as a share of the nation’s economic output, will fall as the job market improves — because that’s how most of our better safety net programs work.

The third myth is that the Temporary Assistance for Needy Families program has been a roaring success and thus should be the model for other safety net programs.

The “proof” cited by the budget plan, as by other proponents of this view, is that the “reforms” it initiated cut caseloads dramatically during the first five years, while poverty rates also fell.

Lots of factors account for both, including a strong economy that made it relatively easy for TANF parents to find work — though often not long-term work at living wages.

But TANF caseloads didn’t expand when the economy cooled in the early 2000s. And, as Legal Momentum reports, only 6.6% more poor adults and children were added to the rolls during the first 19 months of the Great Recession.

That’s not because TANF is so successfully lifting poor families out of poverty. It’s because states have incentives to minimize their caseloads — and the benefits they provide. One of the biggest is the declining value of the federal block grant itself.

They’d have this same incentive if they got a fixed, inadequate sum for their food stamp programs, as they would under the House budget plan.

The plan warns that “the poor and vulnerable will undoubtedly be hardest hit” if the federal government experiences a debt crisis due to runaway spending because the “only recourse will be severe, across-the-board cuts.”

Seems the House Republicans have decided to preempt these hypothetical future cuts by making severe, targeted cuts to safety net programs like food stamps now.


House Republicans Vote To End Food Stamp Program As We Know It

May 5, 2011

I remarked awhile ago that parts of the House Republican Study Committee’s global attack on “welfare” could make their way into legislation that had a better chance of passing.

And sure enough. The budget plan House Republicans have passed includes a provision that would convert SNAP (the food stamp program) into a block grant rather like Temporary Assistance for Needy Families.

Lest one doubt the motive, the plan projects savings totaling $127 billion over the first 10 years alone. The Center on Budget and Policy Priorities estimates losses to the District of Columbia and its food stamp-dependent households at $350 million.

I’ve written elsewhere about what the block grant could mean for households that depend on food stamps to keep food on the table.

Briefly, the block grant would put an inflexible constraint on spending, while presumably increasing flexibility on issues like participation criteria and benefits.

So Congress or states, at their discretion, could — and probably would have to — change eligibility standards so that people would have to be even poorer to qualify for food stamps and/or reduce monthly benefits so that they no longer had any basis in the costs of a nutritious diet.

We can see how the spending cap/flexibility model could play out by looking at states’ TANF programs.

According to a recent Legal Momentum review, only 40% of eligible families were enrolled in TANF in 2005, as compared to 84% in the last year of its non-block grant predecessor.

Cash benefits for a TANF family of three are less than 50% of the federal poverty line in every states and less than 30% in more than half. In all but two, they’re worth less in real-dollar value than when the program was created.

The food stamp block grant proposal has other radical implications.

It would end the long-standing principle that everyone (except some immigrants) whose income falls below the cut-off can get food stamps — and for as long as their income remains that low.

As with TANF, there would be new work requirements. But unlike TANF, there’d apparently be no federal funding within the program for client assessments, job training or the supportive services some recipients would need to meet the requirements, e.g., child care subsidies.

More importantly, food stamp benefits would be time-limited, just as TANF cash benefits are. After some number of years, people would be kicked out of the program, unless states chose to cover the full costs of the benefits themselves.

Would there by any exemptions — say, for people who are too young, too old or too disabled to work? For people who are working but still can’t afford to buy enough food for themselves or their families?

The budget plan doesn’t say. Doubtful the House members who voted for it — or even the drafters — have thought through such consequential details.

All they’re concerned about is cutting federal spending, except when it comes to the more than 50% of annual appropriations that go to the military.

But, like the RSC, the budget plan styles the food stamp block grant as the next step in “the historic bipartisan welfare reform” that gave us TANF.

Here’s hoping we’ve got no bipartisan support for this one — or lock-step support from Senate Republicans either.


Budget Debate Is About Values, Not Numbers

April 30, 2011

New York Times columnist Richard Stevenson provides a good overview of the budget debate underway on Capitol Hill. It’s a “fundamental reassessment of the role and size of government,” he says.

But, as his article suggests, what we’re witnessing is actually a conflict of value systems — core beliefs that extend beyond theories of government.

Republicans are arguing that drastic spending cuts are the only way to avert fiscal disaster — and to create jobs. Most oppose any changes in the tax code that would increase revenues — at least until the unemployment rate has dropped to pre-recession levels. They’re “job killing,” you know.

But neither shrinking the deficit nor boosting job creation drives the Republicans’ agenda. The fact that both reflect the priorities of a wide spectrum of voters gives them an occasion to advance major policy changes consistent with their values.

By and large, Republicans want to whittle the federal government down because their value system puts individual — and corporate — liberty first.

You’re free to choose what you do. And you’re free to keep what you get, less what’s needed for a “robust defense” and presumably other functions that enable businesses to freely grow and prosper.

Thus, the budget resolution the Republican House majority just passed defines government’s “limited but noble mission [as] securing every American’s right to pursue a destiny of his or her own choosing.” And it calls for tax reforms that will let “individuals keep more of what they earn.”

The Democrats have argued that spending cuts right now would cause job losses, but they’ve decided they can’t hold the line. Some would say that the Democrat-in-chief didn’t try hard enough.

But we can’t discount the hard-won recognition that Republicans in Congress can — and will — extort spending cuts as the price for averting national crises. A government shutdown yesterday. Default on the federal debt this summer.

Democrats are nevertheless still coming at our fiscal situation from a different value system. Basically, they’re promoting an agenda that tilts toward our obligations to one another and the good of the whole — obligations that we fulfill through our public institutions.

In other words, they’re placing a high value on the nation as a community. To some extent, this means that individual liberty, as the Republicans conceive it, gives way to “the general Welfare” that’s also envisioned as a goal of the government created by our Constitution.

Beyond this, the agenda reflects the view that we need to act collectively, through our government, to expand opportunity — a necessary, though not sufficient condition for a more equal sharing of the profits generated by economic growth.

Thus, for example, the President wants more funding next year for both Head Start and Title I of the Elementary and Secondary Education Act, the main source of federal funding to improve the education of disadvantaged kids. House Republicans voted to cut current funding levels for both.

I’ve got serious reservations about other parts of the President’s proposed budget — and even more serious reservations about his seeming readiness to embrace even deeper spending cuts.

But I all but stood up and applauded at the end of his speech on his approach to deficit reduction. Because it so clearly articulated the clash in basic values that underlies the current budget debate — one the House budget resolution obfuscates in its claim to “strengthen the social safety net.”

“From our first days as a nation,” the President said, “we have put our faith in free markets and free enterprise…. But there has always been another thread running throughout our history — a belief that we are all connected.”

And “part of this belief expresses itself in the conviction that each one of us deserves some basic measure of security.” So we collectively contribute to programs like Medicare, Social Security and others we commonly refer to as the safety net.

The vision in the House Republicans’ budget plan, he said, “is less about reducing the deficit than about changing the social compact in America.” I think that’s right on target.

And, as Stevenson observes, Republican leaders and their supporters objected to “the implication of heartlessness, but not necessarily to his assessment of their ambition.”


How Congressman Ryan’s Radical Health Care Proposals Would Impact DC

April 12, 2011

Now the answer to a question I’ve been asking myself ever since I looked at Congressman Paul Ryan’s proposals for federal health care programs. What would they mean for the District of Columbia and its residents?

Families USA has just issued a report with state-by-state impact figures for each of the major health care parts of Ryan’s Fiscal Year 2012 budget resolution — his so-called Pathway to Prosperity.

Here’s what we learn.

Medicaid Block Grant. As you may recall, the Ryan plan would convert Medicaid to a block grant. Grants would be adjusted according to a formula that reflected neither rising health care costs nor the aging of the population. The latter is important because state Medicaid programs spend more for low-income seniors than for most other covered groups.

Under the block grant, the District’s existing program would lose $4.4 million next year. Losses would grow exponentially every year thereafter. For the entire first 10-year period, 2012-2021, they would total more than $3.4 billion.

Funding for Medicaid Expansion. Under the health care reform act, states must expand their Medicaid programs to include all people with incomes at or below 133% of the federal poverty line. The federal government will pay all the costs of the expansion for the first three years and most of the costs thereafter.

The Ryan plan would repeal both the expansion requirement and the related funding. Losses to the District by 2021 would reportedly total well over $1.2 billion.

“Reportedly” because Families USA assumed that the District would undertake the expansion in 2014, as the law requires. I understand it’s decided to move at least some eligible residents into Medicaid earlier. This might affect the estimate.

Tax Credits for Insurance Premiums. The health care reform act includes tax credits to help moderate-income families purchase health insurance in the exchanges that will be created. Credits will be available to families up to 400% of the federal poverty line.

The Ryan plan would repeal this provision also. District residents eligible for the tax credits would lose $37.4 million in 2014, the year they’d become available under the current law.

Here again, losses would dramatically escalate. During the 2012-21 period, they’d total close to $1.3 billion.

The health care reform act also provides tax credits for small businesses and some other incentives to encourage employers to provide health insurance. These too would be repealed under the Ryan plan.

Loss of all the tax credits, plus the loss of federal funding for expansion of Medicaid would mean that at least 46,600 District residents would have no health insurance 10 years from now.

Medicare Privatization. Under the Ryan plan, people now under 55 would be subject to an altogether different health insurance scheme when they reached Medicare eligibility age or became severely disabled before that.

Instead of enrolling in the fairly comprehensive, low-cost insurance plan we know as Medicare, they’d get the equivalent of a voucher to purchase health insurance in the private market. As I noted earlier, the value of the voucher would increase at a much lower rate than health care costs.

Families USA doesn’t provide state-by-state figures for the budget crunch that seniors and people too disabled to work would face. The Congressional Budget Office, however, did some preliminary national estimates.

According to these, typical 65 year olds enrolled in a private insurance plan similar to the current Medicare would pay 68% of their health insurance premiums and out-of-pocket costs in 2030. This is 43% more than what they’d pay under Medicare as it exists today.

And the total costs would be much greater because Medicare delivers more health care bang for the buck than private insurance plans.

Bottom Line. If the Ryan proposals for Medicaid, Medicare and health insurance tax credits were all adopted, the District and its residents would lose more than $6 billion in the first 10 years alone.

And for what? So that $4.2 trillion could be used to finance extended and expanded tax breaks that would make the wealthiest even wealthier.