Inside the GOP's secret plan to destroy Medicaid

Listen to House Speaker Mike Johnson, R-La., on Fox News a couple of weeks ago talking about the need to preserve the state-federal programme so it serves 'young single mothers down on their fortunes for a moment, the people with real disability, the elderly'

- Michael Hiltzik

You may have heard some of our federal lawmakers attest to their respect for Medicaid and its generally low-income enrolment base.

Listen to House Speaker Mike Johnson, R-La., on Fox News a couple of weeks ago talking about the need to preserve the state-federal programme so it serves "young single mothers down on their fortunes for a moment, the people with real disability, the elderly." As articulated by Johnson and other GOP lawmakers, this idea seems pretty unexceptionable. Unless, that is, you examine what's really behind this declaration of service for the less fortunate among us.

What they're really talking about is killing the Medicaid expansion that was passed as part of the Affordable Care Act in 2010. They have a plan to do exactly that. It's not exactly secret, but it's abstruse enough that they hope most people, who aren't fully conversant with the complexities of the programme, won't get the drift. So I'm here to explain what they're up to. To understand, you have to be aware of two facts. One is that the federal government contributes 90% of the cost of medical service for expansion enrollees.

The other is that the federal match for traditional Medicaid, which principally serves low-income families with children, is lower. It varies state by state and ranges from 50% for wealthier states such as California to more than 70% for poor states such as Mississippi, Alabama and West Virginia. The idea floating around in the GOP caucus is to reduce the expansion match to each state's level for traditional Medicaid. The idea can be found in Project 2025 and in a proposal from the Paragon Health Institute, which has been funded in part by right-wing foundations, including the Koch network. Make no mistake: This is an effort aimed at destroying Medicaid expansion programmes. The healthcare of as many as 21 million Americans is at stake; that's how many people are receiving health coverage via the Medicaid expansion.