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Pelosi and Hoyer: ‘The Democratic-led House will not allow this challenge to health care access in our country to go unanswered.’
The biggest news out of Washington this past Friday, the news with the most impact on the November election, had nothing to do with the Senate’s denial of witnesses or evidence in the impeachment trial. At 4:51 p.m. Eastern Time, the Democratic House leadership quietly announced the introduction of a resolution of disapproval over the Trump administration’s proposed Medicaid block grant scheme, which would reduce or deny access to health care for millions of Americans. While “resolution of disapproval” sounds about as aggressive as a sternly worded letter, it could put every Republican in Congress on the record on cuts to health care, the very issue that won Democrats the 2018 midterm elections.
The House Democratic announcement came only a day after the rollout of the Medicaid block grant plan, which states could employ to cap total spending on a program that serves over 70 million Americans. Currently, Medicaid is open to all who are eligible—37 states and D.C. have expanded eligibility for Medicaid up to 138 percent of the poverty level, while the other 13 states have much lower thresholds. Since Medicaid’s inception, the costs to provide medical care to the eligible population are covered; the feds provide a large share of funds under a formula, and the states supplement it.
Under a block grant system, however, states would apply to get a fixed amount of funding, and then would have flexibility to design Medicaid differently. They could limit prescription drug coverage, reduce the scope of covered benefits, omit Medicaid features like long-term care or transportation to appointments, or tighten eligibility. The Trump administration’s cap would just apply to the Medicaid expansion population. But the entire point is to allow states to cut Medicaid spending, widening the gap between how different parts of the country treat the poor.
As health care costs grow above the rate of inflation over time, the spending cap would only grow more onerous. And in an economic downturn, when more people become eligible for safety-net programs like Medicaid, there would be less money to accommodate the demand. The program, in other words, would effectively contract right when need is greatest.
We know exactly what this looks like, because it’s how the welfare program changed in the 1990s under Bill Clinton and the Gingrich Republicans. They block-granted welfare payments to states, which worked fine when the economy expanded rapidly in the late 1990s. But after the dot-com bust, 9/11, the financial crisis, and the associated recessions, fewer people could access welfare benefits, and it became increasingly irrelevant as a lifeline for the desperately poor. That’s the road that the Medicaid block grant program is walking down.
Block-granting Medicaid has been a conservative dream for close to 30 years, plotted in quiet rooms far from the campaign trail. But the Trump administration says the quiet parts out loud, and establishing a block grant in an election year is sure to be political fodder. Democrats have demonstrated the capacity to bash Republicans over cuts to health care; it was the chief topic of the midterms and still remains atop the list of issues for voters.
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Though this is only a proposal, Congress can register opposition with a resolution of disapproval, a tool originated in the Congressional Review Act of 1996. Using the CRA, Congress can introduce resolutions of disapproval to overrule any regulation issued by an executive branch agency. If both houses of Congress pass the resolution and the president signs it, such a rule can never be promulgated again unless Congress gives its express consent. Back when Republicans controlled the House as well as the Senate, Trump and congressional Republicans used the CRA to overturn 16 rules that the Obama administration’s executive agencies had worked on.
With Trump still president, it’s highly unlikely that any rule his agencies proposed would ever be overturned. But the unique nature of the resolution of disapproval can force the members of Congress to at least make known their preferences on cuts to health care for the poor.
Democrats in the House, obviously, can and will pass the resolution of disapproval. According to the statement of Speaker Nancy Pelosi and House Majority Leader Steny Hoyer, the resolution will get a vote this Thursday, February 6. “The goal of this new waiver is clear: reduce access to health care for millions of low-income Americans, including access to affordable prescription drugs,” wrote Pelosi and Hoyer in their statement. “The Democratic-led House will not allow this challenge to health care access in our country to go unanswered.”
Typically in this Congress, such efforts have ended at the House vote, as Mitch McConnell fills up his legislative graveyard. But a resolution of disapproval has special properties that will force the Senate to act. Any senator can file a companion resolution to the committee of jurisdiction in the Senate (in this case, either the Finance Committee or the Health, Education, Labor and Pensions Committee). If that committee doesn’t report out the resolution within 20 calendar days, a minority of 30 senators can discharge it out of committee and place it on the Senate calendar. Any senator—including Democrats in the minority—can call it up for a motion to proceed. That motion is nondebatable and cannot be filibustered.
We know exactly how block grants affect safety-net programs, because that’s how the welfare program changed in the 1990s under Bill Clinton and the Gingrich Republicans.
Democrats used this in 2018 to disapprove of the IRS’s rule to allow tax-exempt organizations to hide donor names. The Republican House never took it up; there are no rules for the minority party in the House to force a resolution of disapproval to the floor. But there are in the Senate.
Certainly, Republicans can use their 53-vote majority in the Senate to vote down the motion to proceed. But that’s essentially a proxy for putting them on the record on the Medicaid block grant. So Susan Collins, Cory Gardner, Martha McSally, Joni Ernst, Thom Tillis, and every other Republican facing voters in November will effectively have to vote on whether or not they agree that Medicaid should be cut for millions of Americans. These are the kind of votes that Mitch McConnell has tried so desperately to avoid, to shield his caucus from the appearance of heartlessness.
Of course, these senators have the option to, well, not be so heartless. They could vote to proceed on the resolution. That would set up another vote with only ten hours of debate, not subject to the filibuster or amendment. With the vulnerable Republicans joining Democrats, this could get all the way to the president’s desk.
He would in all likelihood veto the bill. But that would put Trump on the record once again on cutting Medicaid, supplementing his drive to repeal the Affordable Care Act and add work requirements to Medicaid. This would be more tangible than placing Medicaid block grants in a budget or a rule. It would be a direct action of the president to roll back health care. And Democrats would be poised to strike back.
However this works out, I predict there will be more general-election campaign ads run on this Medicaid issue than on impeachment. Block grants to Medicaid are incredibly unpopular; even Republicans split 50/50 on the question. Just watch Vice President Mike Pence confronted on Medicaid cuts last week at a diner in Iowa; he had no response. Trump knows that he needs to take credit for lowering health care costs, and the block grant complicates that plan. It’s a self-inflicted political wound, and with the resolution of disapproval, Democrats are poised to deepen it.
