Medicaid advocates remain worried that the state-federal program for low-income Americans remains on the chopping block as debt ceiling negotiations enter the final stretch.

Congressional Democrats' on-again, off-again pledge to protect the program from drastic cuts is causing heartburn among advocates for the poor and state officials who worry about the lawmakers' commitment. In particular, the Democratic leadership has at times left out any mention of Medicaid when vowing to fight entitlement cuts.

House Minority Leader Nancy Pelosi (D-Calif.) rekindled some of those concerns with her statement Thursday evening after negotiations hosted by President Obama broke down.

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"After several days of comprehensive discussions, the President asked the bicameral, bipartisan leadership to go to our respective caucuses to see what could be passed. I told the President that the House Democratic Caucus stands with him in support of the 'grand bargain‚' saving up to $4 trillion while avoiding an unprecedented default crisis," Pelosi said.

"House Democrats want a final agreement that reflects the 'grand bargain‚' while protecting Social Security and Medicare benefits. Democrats are committed to ensuring that our nation meets its obligations by working toward a long term plan to reduce the deficit, create jobs, grow the economy and strengthen the middle class."

She repeated that sentiment during a press conference Friday.

"We continue to say to the President: 'Congratulations. We are proud of the work you are doing, and we are glad that it does not reduce benefits for Medicare and Social Security beneficiaries'," Pelosi said Friday. "It doesn't mean we are not open to initiatives that will strengthen those, Medicare and Social Security, that will cut cost and keep them solvent for a longer period of time. But we are not reducing the deficit on the backs, and give tax cuts to the wealthy, on the backs of our Social Security and Medicare recipients."

One Medicaid advocate said Pelosi's failure to mention the program is a missed opportunity. The source said Democratic staffers tell advocates that references to Medicare really include Medicaid as well, but that they want to keep their message simple; however, the advocate points out, President Bill Clinton William (Bill) Jefferson ClintonNew poll finds Biden narrowly leading Trump in Georgia Changing the climate of presidential debates Davis: My advice to Joe Biden on eve of the debate — be Joe Biden MORE managed to keep the program top of mind with his M2E2 - Medicare, Medicaid, Environment and Education - motto during Balanced Budget Act talks.

"A lot of us have been really irritated by it," the advocate said. "You can make a message pretty simple that includes Medicaid."

The advocate explained that the messaging is important now as both Democrats and Republicans have vowed to take more and more healthcare cuts off the table, including deeper rebates for drugmakers. That leaves many advocates worried about a proposed $100 billion Medicaid cut the White House proposed to attain by blending and lowering reimbursement rates for different programs.

"As all of these things come off the table, what's left?" the advocate asked rhetorically.

Pelosi's office says the leader remains fully committed to programs for the poor, and point to her past statements.

"These discussions take a heavy toll on women if they do not come out right," she said Thursday, for example. "Women understand the need for Social Security, for Medicare, for Medicaid. They are beneficiaries, and even before then they are caregivers and they are responsible for much of the care in their own families."

Other advocates aren't as worried.

The $100 billion blended rate cut, Families USA Executive Director Ron Pollack told The Hill, was in the context of a $4 trillion deficit deal that would have included revenue raisers. Given Republicans' inflexibility on the subject, he said, there's no reason to believe that the White House is willing to cut a program it cherishes by anywhere near that amount.

"I would not make too much out of that $100 billion proposal, which was meant for a very different context than the context we're likely to see come out of the negotiations," Pollack said. "I wish the word Medicaid was used more frequently, but I do think there is great sensitivity by the Democratic leadership to potential cutbacks in Medicaid."



