The Republican proposal to alter last summer’s budget deal will come up for a vote on Thursday. It will almost surely pass and then, almost as surely, go nowhere in the Senate. But it’s yet another revealing window into Republican priorities. As you may recall, the agreement to raise the debt ceiling in 2011 came with a promise to cut future spending.
Democrats didn’t see it coming: Before the passage of the Affordable Care Act in 2010, neither congressional leaders nor the White House anticipated that one specific provision—the mandate requiring individuals to maintain a minimum level of health insurance—would spark such a ferocious political and legal backlash. Yet, nearly two years later, controversy surrounding the mandate dominates the national conversation about health care reform.
In the coming debate over the future of Medicaid, you’re going to keep hearing one word: “Flexibility.” It’s what many governors covet and what the Republicans propose to give them: The ability to design state Medicaid programs however state officials want, free(r) of federal rules about who to cover and in what way. I don’t think the case for flexibility is particularly strong, in part because the states already have some of it. But make no mistake. The Republican proposal isn't exclusively or even mostly about flexibility.