One of the amazing things about Bill Clinton's tour de force last night at the Democratic Convention was his decision to put Medicaid at the heart of his speech. No piece of the safety net is more at-risk of devastation from federal budget cuts than Medicaid, but many politicians have accepted the cynical and incorrect idea that the program serves poor people, so why stand up for it?
In contrast, Clinton gave a clear defense of the importance of Medicaid to the lives of millions of American families. As he has done on other issues, he explained how Medicaid benefits both the poor and the middle class, rightly explaining that while the program provides health coverage to many poor children, two-thirds of spending goes to nursing homes for seniors and care for the disabled.
Clinton has no peer when it comes to breaking down complex policy issues in terms that make sense to people. He used that gift to explain that the budget passed by the House of Representatives last March would cut Medicaid by one-third and turn the program into a block grant. The human consequences of this would be devastating. According to the Urban Institute, depending on how states responded to this level of cuts, between 14 and 27 million Americans could lose their health coverage entirely. As Clinton said, "And honestly, let's think about it, if that happens, I don't know what those families are going to do."
As I listened to President Clinton talk about families whose kids have Down syndrome or autism or other severe conditions, I thought about my son who was diagnosed with hearing loss at 17 months old. When our insurance company would not cover the cost of hearing aids, it was the Pennsylvania Medicaid program that helped us buy them. I expect that many people listening to that part of the speech were thinking about visiting family members in nursing homes. It should comfort us that after people have exhausted their savings they can avoid pain and suffering and ultimately die with dignity because of the Medicaid program. What could be more immoral and wrong than undermining that peace of mind to finance yet another round of tax cuts for the wealthiest Americans, as the House budget does?
The reality is that most Americans don't make a big distinction between Medicare and Medicaid. Many don't know the difference between the two programs, and it really doesn't matter that much. Even President Clinton said Medicare when he meant Medicaid at one point in his speech. But we got his point. People understand that these two elements of the safety net -- signed into law at the same time in 1965 by President Lyndon Johnson -- work hand-in-hand to protect people as they age or experience tough times.
It is the political class that is out of touch on this issue, making a distinction in political attractiveness where it makes no real sense. Public opinion polls show that, by wide margins, Americans support Medicaid and don't want to see it cut. We are seeing some very promising efforts in cities and states to improve how Medicaid works. With millions of Americans poised to receive Medicaid cards as a result of the Affordable Care Act, the real work in Washington, D.C., should be strengthening the program, and especially making sure that people with coverage can find good high-quality primary care.
Let's hope the politicians from both parties really listened to President Clinton speak last night. Let's hope that they heard the message that not only is protecting and strengthening Medicaid the right thing to do, but that it is also a great way to connect politically with families facing uncertain times.