Bill Clinton, Medicaid and the Politics of Poverty

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Former President Bill Clinton speaks in Charlotte, N.C., on Sept. 5, 2012

Buried amid Bill Clinton’s rhetorical smorgasbord on Wednesday night was a short but fascinating passage about Medicaid, the federal entitlement program for the poor and disabled. Here’s what Clinton said:

Now, folks, this is serious, because it gets worse. And you won’t be laughing when I finish telling you this. They also want to block grant Medicaid and cut it by a third over the coming 10 years. Of course, that’s going to really hurt a lot of poor kids.

But that’s not all. A lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid.

It’s going to end Medicare [sic: he probably meant Medicaid] as we know it. And a lot of that money is also spent to help people with disabilities, including a lot of middle-class families whose kids have Down’s syndrome or autism or other severe conditions.

And, honestly, just think about it. If that happens, I don’t know what those families are going to do. So I know what I’m going to do: I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen. We can’t.

Two interesting things here. One, it’s striking to hear Clinton make such a direct reference to the “poor.” National politicians don’t talk much about poverty these days, for reasons underscored by the Romney campaign’s misleading attacks over welfare reform: at a moment when the middle class is reeling, compassion for the poor competes with resentment for the benefits they draw from the government. It’s an extra-tricky topic for Democrats and especially Barack Obama, because poverty is tangled up with race in the minds of voters. Note that Clinton chose to refer to “poor kids,” probably on the assumption that “the poor” just doesn’t move people enough.

And what about the Republicans? To be fair, Mitt Romney’s Tampa acceptance speech did feature this:

Today more Americans wake up in poverty than ever before. Nearly 1 out of 6 Americans is living in poverty. Look around you. These are not strangers. These are our brothers and sisters, our fellow Americans.

But little else about the Romney campaign demonstrates much interest in the plight of the impoverished. And although Paul Ryan — who in Tampa used the same “Nearly 1 in 6 Americans is living in poverty” line, verbatim — cites Jack Kemp as a political mentor, some of Kemp’s former associates note that the late New York Congressman obsessed over the fate of low-income black Americans. Ryan doesn’t have much to say on that topic.

(PHOTOS: The Democratic National Convention)

Clinton’s Medicaid riff was about more than poverty, however. While Democrats aren’t likely to seize on protecting the poor as a central issue, Clinton may have opened an important new front with his reference to Medicaid’s coverage of nursing-home care for seniors. Romney and Ryan vow not to touch Medicare benefits for anyone currently 55 or older. But they have made no such assurance about Medicaid. On Wednesday, Clinton reminded Americans that plenty of seniors — and the middle-aged who are often responsible for them and are stressed about their care — depend on both programs. (More than 8 million seniors are dually eligible for Medicaid and Medicare because of low income or disability.) It turns out that Clinton overstated how much Medicaid spends on this population, but it’s still 39% of the program’s medical-services spending. And it seems fair for Democrats to warn seniors that Romney’s Medicaid cuts pose a direct threat to their benefits. I’d be amazed if we didn’t hear more about this in the home stretch of the campaign — even if we don’t hear much more about poverty in America.