A Save for Medicaid

By rejecting President Bush’s cuts to Medicaid, the Senate Thursday revived hope that states would be able to continue programs that deliver health care to the poor and those just above the poverty line without health insurance. The vote on $14 billion worth of Medicaid cuts was a rebuke to the president’s priorities for domestic-budget discipline, but the test of whether the money will remain in the budget comes with the House and Senate reconciliation, where the fight will be more difficult.

The Medicaid provision was written by Sen. Gordon Smith, R-Ore., and Sen. Jeff Bingaman, D-N.M., and would direct a commission to study the size and reach of Medicaid, including an examination of the sense by some that states use these dollars as a slush fund. Sen. Olympia Snowe became a co-sponsor of the bill Wednesday, but it was unclear how Sen. Susan Collins would vote – on Thursday, a story in Congress Daily described Sen. Collins going into Majority Leader Bill Frist’s office to discuss the issue, saying, “I’m going in there to get hammered.” The pressure on her in the Senate not to become the 51st vote on the Smith-Bingaman amendment was considerable, but she stood up for states and backed the bill, a position she held all along.

Her reluctance in making that known, she said, was based on a concern with the amendment’s time frame, which gives a commission a year to report back to Congress, too late for savings in the next budget. That’s a fair criticism, especially when there are already ideas for savings that could gain wide support, such as charging co-pays for those who fall outside the standards for Medicaid but whom states cover anyway.

On another important vote, the Senate approved a $64 billion increase in the size of the budget’s tax cuts over five years to $134 billion. The added cuts, introduced through an amendment by Sen. Jim Bunning, R-Ky., was to repeal a 1993 tax increase on Social Security benefits. Sen. Snowe voted against the measure, and, for that matter, the entire budget resolution; Sen. Collins voted in favor of both, though only after voting against the $70 billion initial cuts and noting that the budget had been considerably improved on the floor with important new funding for education, such as Pell grants, and for her own amendment to restore money to Homeland Security.

None of these funding changes can occur until House and Senate members agree jointly on them, and the Medicaid money promises to be a contentious issue – the House would reduce that funding by $20 billion. But the Senate has a better plan and the health care money should remain until Congress comes up with a better way of providing health insurance to the millions of Americans who are without it.