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Where Does The Federal Budget Deficit Fit Into The Health Care Equation?


We're going to turn back to the health care bill presented by Senate Republicans last week. They say the plan will cut costs and stabilize insurance markets. Yesterday, we heard from Lynn Cooper of Pennsylvania's Rehabilitation and Community Providers Association, which represents facilities that treat substance abuse. She was particularly concerned about the proposed caps on Medicaid, the national program that pays for health care for people with low incomes. She said it would be devastating at a time when the nation is struggling to contain a crisis of opioid abuse.


LYNN COOPER: The loss of Medicaid expansion will be like the bottom dropping out for thousands of Pennsylvania citizens and their families.

MARTIN: Today, we wanted to get perspective from a different vantage point from someone who's primarily concerned about the size of the federal budget and the federal deficit. Maya MacGuineas is president of the committee for a Responsible Federal Budget. It says it's a nonpartisan organization focused on fiscal responsibility in government. She also chairs a group called The Campaign to Fix the Debt. And she's with us now. Maya, thanks so much for joining us.

MAYA MACGUINEAS: Thanks for having me.

MARTIN: So let's talk about why you and others who share your perspective believe that restraining the cost of entitlement programs, of which Medicaid is one, is so important. Why does that matter?

MACGUINEAS: So right now, we have a federal debt that's the highest it's ever been since World War II. That affects our economy. It affects wages. It lowers our standard of living. So we need to get control of the national debt. The fastest drivers of the debt come from the aging of the population and growing health care costs. So focusing on cost control of health care and our Medicare and Medicaid programs will give us more freedom in the budget so that we're not borrowing hundreds of billions of dollars every year.

MARTIN: As I mentioned earlier, yesterday, we spoke with a woman who represents Pennsylvania's drug rehabilitation programs. And she was telling us in fairly graphic terms how, you know, capping Medicaid in her view could harm tens of thousands of people in her state alone. And this at a time when the opioid problem is being called a national crisis. So how do you make the argument that their needs right now are less important, if I could use that term, than the long-term need to control costs?

MACGUINEAS: So I wouldn't make the argument that any particular group or person's needs are less important. I would make the argument that we need to look at a budget as what budgets are actually supposed to be, which is trade-offs. So what we need to do is figure out what our national priorities are. And then we need to figure out how we're going to pay for it. I would argue that the most important thing is that we ensure everybody is able to afford a reasonable amount of health care.

Now, people will disagree on what reasonable amount is, and that's a big part of where the fight is. But we want to make sure that the subsidies are flowing to people who we should be subsidizing. And there's different questions. Do we have the young subsidize the old, the healthy subsidize the sick, the rich subsidize the poor? There is no one right answer, but you have to make some choices. And budgets push us to make choices.

MARTIN: Does this argument become more difficult, speaking of trade-offs, when it appears that the agenda of this administration - and frankly, congressional Republicans at the moment - is to use these costs savings to provide tax cuts which disproportionately benefit the wealthy?

MACGUINEAS: Well, it makes it more difficult for those of us who care about reducing the deficit because if I were structuring something like this, I would keep that revenue because we need it. And I would worry about, how are you going to make sure that people who need health care get it as efficiently as possible? How do you control the cost of health care? And how do you help use these savings to bring our debt down before we go forward with cutting taxes?

Which it seems like at a time of record debt levels, tax cuts don't make a lot of sense. And that does include making reforms to entitlements and thinking about things in Medicare and Medicaid. People never like those changes, but you actually can't get control of these programs if they go uncapped with no control.

MARTIN: Maya MacGuineas is president of the Committee for a Responsible Federal Budget and The Campaign to Fix the Debt. Maya, thank you so much for speaking with us once again.

MACGUINEAS: Thanks so much for having me. Transcript provided by NPR, Copyright NPR.

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