After a bruising Washington battle that averted a government shutdown but broke their party in two last week, leading California Democrats are trying to project a unified front on a central issue in the next big budget fight: Medicaid.
Republicans have already signaled their intention to cut hundreds of billions of dollars from the healthcare program for low-income residents, people with disabilities and other vulnerable groups in order to pay for tax cuts for the rich, the Democrats said — and must be stopped.
“Our budget should be a statement of our national values. What is important to us should be reflected in that budget. But what we see now is an assault on our values as they make this assault on our budget,” Rep. Nancy Pelosi said Tuesday at a UC San Francisco medical facility in her district, flanked by several other members of Congress, local doctors, community advocates and Medicaid recipients.
The event was part of a broader nationwide effort among Democrats to align on a clear message about Republican budget priorities that they say are threatening the well-being of average Americans — and before the frantic final days of negotiations or any vote in Washington.
They do not want to repeat the mistakes of last week, when Democrats split over the GOP’s stopgap measure to avoid a federal government shutdown.
Party leaders were accused of putting out muddled messaging about what was at stake, capitulating to Republicans in a rare moment when they had leverage, and handing President Trump and his party an important win at a time when they are running roughshod over the federal government and normal, bipartisan processes for funding it.
The episode exposed deep fissures in Democratic Party strategy, with former House Speaker Pelosi even making a rare and unsuccessful plea to Democratic senators to break with their leader, Senate Minority Leader Chuck Schumer of New York, and oppose the stopgap measure.
But on Tuesday, Pelosi and Schumer appeared aligned once more, if not on last week than at least on how to move forward. Pelosi’s event was part of a “Medicaid Day of Action” that Schumer had touted hours earlier on ABC’s “The View.”
“We have senators and congressmen going to all different parts of their states and districts talking about how bad the Medicaid cut would be,” Schumer said.
“We don’t agonize, we organize, and this day, today, we have scores of events across the country, starting in New York,” Pelosi echoed hours later. “And we’ll have them tomorrow and the next day and the next day.”
A host of Democrats held smaller events and roundtable discussions with healthcare providers in their own districts, including Rep. Sydney Kamlager-Dove in Los Angeles and Rep. Ted Lieu in Redondo Beach. Protesters also decried Medicaid cuts outside the Anaheim Hills office of Republican Rep. Young Kim.
The Democrats say their hyper-focus on Medicaid is not just bluster — though Republicans have framed it as such.
Trump has repeatedly said that his party is not going after people’s Medicare, Medicaid or Social Security benefits, and the White House has acted exasperated by claims otherwise, saying the administration supports only the elimination of fraud and abuse in such programs.
“What kind of a person doesn’t support eliminating waste, fraud and abuse in government spending that ultimately costs taxpayers more?” it said.
Republican members of Congress have made similar arguments, accusing Democrats of lying about Medicaid cuts just to rile up their base and win political points.
A protester holds a sign outside Senate Minority Leader Chuck Schumer’s office last week after he said he would vote to advance a GOP-written funding patch to avert a government shutdown, saying it was the better of two bad options.
(Michel Nigro / Pacific Press / LightRocket via Getty Images)
However, Republicans brought on the concern themselves by passing a budget resolution last month aimed at extending 2017 tax cuts, including by finding trillions of dollars in spending cuts to pay for them.
That resolution does not explicitly require Medicaid cuts, but it instructs the House Energy and Commerce Committee, which oversees Medicaid, to cut spending by $880 billion over the next decade.
Democrats say simple math makes clear that the only way the committee will be able to find that level of cuts is by cutting Medicaid, unless they want to cut Medicare, the health program for seniors, which Republicans have also said is off the table. The committee could cut everything else in its budget — completely — and still wouldn’t reach the savings Republicans have called for, an independent analysis by the Congressional Budget Office concluded.
At Pelosi’s event, Rep. Mike Thompson (D-St. Helena), the ranking Democrat on the House Ways and Means subcommittee on tax policy, said Republicans who are denying that their budget resolution calls for cuts to Medicaid aren’t telling the truth.
“We’re here because this president and the Republicans in Congress want to decimate Medicaid. They say no, they’re not going to touch Medicaid. That is a bald-faced lie,” Thompson said.
Medi-Cal, California’s version of Medicaid, covers nearly 15 million Californians, or more than a third of the state’s population, according to recent estimates from state health officials. Many of those patients are children.
But, as Thompson and others at the event noted, many others in the state would be affected by Medicaid cuts as well, because they would kneecap health systems and hospitals — particularly in rural and other poor communities where Medicaid patients make up a larger percentage of patients.
“We need to make sure our colleagues in red districts across the state understand this and they speak out,” Thompson said.
Sen. Adam Schiff agreed, calling such cuts “absolutely devastating to healthcare around the country, and most particularly to states like California that have so many of our residents who utilize Medicaid.”
Schiff said that healthcare systems throughout the state, especially in rural areas, are already in a “precarious position” financially, and that cutting Medicaid funding would set into motion a “cascading set of closures of hospitals and clinics.”
Dr. Josh Adler, executive vice president and chief clinical officer at UCSF Health, said more than 70% of the system’s in-patient care is roughly split between Medicare and Medicaid patients. Last year, he said, 58% of emergency department patients and 35% of the system’s in-patient population relied on Medicaid.
The cuts envisioned in Congress would “severely weaken the healthcare system that millions of Californians rely on for high-quality primary care and secondary care, while increasing the uncompensated care costs for hospitals that are already financially stressed,” he said.
Dr. Amy Herold, an OB-GYN and chief administrative and chief medical officer for Providence Queen of the Valley Medical Center in Napa, said her region is known for its tourism but is really a rural farming and service community — which is reflected in her system’s users.
Herold said 75% of the hospital’s patients are on Medicare or Medicaid, with more than 30% on Medicaid, and “that goes up to over 50% when you look at our pregnant ladies having their babies, including the one I delivered two days ago.”
The proposed cuts would make it difficult for her hospital to stay open, she said, despite the fact that it is the only one in her county with a trauma center and a labor and delivery center.
“There will be a healthcare desert, so not only do the people that are on Medi-Cal/Medicaid not have access to care, anyone — regardless of your insurance status — will not have access to care,” she said. “This is what keeps me up at night.”
Sascha Bittner, who serves on San Francisco’s Disability and Aging Services Commission and who is quadriplegic and has a speech disability and a vision disability from cerebral palsy, credited Medicaid with saving her life by providing her with home and community-based support and an array of healthcare services. In 2013, she said, she spent five months in the hospital with lymphoma, which would have cost her life or bankrupted her family without Medicaid.
“There are disabled children, elderly and other vulnerable people like me who depend on Medicaid,” Bittner said, “and the Republican plan to gut this crucial support is an attack on our very lives.”