Austin Scott opens the Medicaid can of worms

U.S. Rep. Austin Scott is the longest-serving of Georgia’s nine Republican congressmen, but you wouldn’t know it from the headlines he’s generated. Nothing in his 15 years in Washington has caused as much of a stir as the time when, as a young state representative, he voted to remove the Confederate battle emblem from the state flag.

He’s been a loyal Republican but much more in the mold of an earlier generation of Georgians in Congress who paid attention to farm subsidies and military bases and generally stayed out of the news.

That nose-down image is part of why there’s been no more attention paid to one of the biggest financial and political stories of the year so far.

The federal government shares the costs of Medicaid using a formula based on a state’s average per capita income, from California and nine other states (the feds pay 50 percent) to Mississippi (feds pay 76.9 percent). But as an incentive to join the program, the feds pay 90 percent of the extra expenses for the Affordable Care Act’s Medicaid expansion.

Last week in an interview with Maria Bartiromo on Fox Business, Scott laid out House Republicans’ budget-cutting plans.

“What we have talked about is moving that 90 percent level of the expansion back towards the more traditional levels of 50 to approximately 80 percent instead of the 90/10,” Scott said.

This may not sound like such a big deal, and indeed, the money being talked about here isn’t the major part of what the federal government pays for Medicaid. But the mere fact that it puts Medicaid cuts on the table as a concrete proposal is a major development. And as such, it opens a can of worms.

“Nobody would be kicked off of Medicaid as long as the governors decided that they wanted to continue to fund the program. And so we are going to ask the states to pick up and pay some additional percentage of the Medicaid percentage,” Scott continued.

Seldom does so much hang on the phrase “as long as,” as here. The states that were the last to buy into Medicaid expansion would probably be the least likely to accept a higher level of fiscal responsibility for it, leading to even wider divergencies in care. Georgia is one of 10 states that haven’t accepted Medicaid Expansion, as Scott is well aware.

The political window through which something like this could be accomplished gets narrower by the week. It would be a mid-term nightmare for Republicans, especially those whose districts in blue states were early expanders.

With all that being said, Scott’s remarks amount to the most serious proposal for cutting the federal deficit anyone in Washington has made this year. Looking at you, Elon Musk.

The world’s richest man has so far demonstrated no grasp of the federal budget he has pledged to bring under control. He has gone from pledging to cut $2 trillion to $1 trillion to ambitions more in the billions. The Department of Government Efficiency says it has saved $160 billion so far, but an analysis by BBC only found $32.5 billion with receipts attached.

Not long after DOGE began its pledge-week spree through the federal workforce, Facebook became populated with breathless memes about all the scandals it was uncovering, the billions just in dead Social Security recipients alone. These get the faithful excited, then fade with a lack of verification.

There can be no meaningful progress toward reducing the federal deficit, which doesn’t address Medicare, Medicaid and Social Security. This is pretty widely understood among most who keep up with the subject. The only Americans who don’t understand this are the ones toward whom all these wild DOGE claims are aimed. There is waste, fraud and abuse. There are no bottomless pits of waste, fraud and abuse that will solve all our problems for us.

The idea Scott talked about out loud may not be politically feasible, might have legal problems, and would impose some real pain on the states. Despite these problems — you might even say, as demonstrated by these problems — it’s not just clickbait for the poorly informed. It’s a real effort to address the problem.