

(By Akira Hakuta/The Washington Post)

That shouldn’t be the case. Medicaid is a bigger program than Medicare, serving more than 50 million people, to Medicare’s 48 million. Nor does it poll substantially worse. A recent Kaiser tracking poll found that 88 percent of Americans wanted either no reduction or small reductions in Medicare funding. At 83 percent, Medicaid was close on its heels. And given those poll numbers, both programs should be bulletproof.

But, for a host of reasons, Democrats worry that Medicaid is more endangered than people realize. Politicians are afraid of Medicare because its beneficiaries — seniors — turn out to vote. But Medicaid mainly serves children, the disabled and the very poor. Those aren’t groups renowned for their clout at the ballot box. And though Democrats have ferociously assailed the Republican Party’s plans for Medicare, the party has been quieter on Medicaid.

So Rockefeller, the chairman of the Senate Finance Committee’s Subcommittee on Health Care, is trying to make some noise. Earlier today, he sent the administration a letter signed by 37 Democrats opposing the Republican budget’s changes to the program. Four other Democrats sent their own letter. That makes 41 — a filibuster-proof block. “That’ll surprise people,” he says. “Now, signing a letter is easier than casting a vote. But in government, if you float something out there and people don’t say much, people mistake that for acquiescence. I think this is getting to be the time where people are going to start fighting back.”

The Obama administration, to its credit, hasn’t been silent on Medicaid. “From a policy perspective, from a values perspective, we should be very deeply troubled by the Medicaid cuts in the House Republican plan,” said Gene Sperling, director of the National Economics Council. But the concern isn’t that the House Republicans will somehow sneak their Medicaid proposals though the debt-ceiling negotiations. After all, their Medicaid proposal would, among other things, effectively repeal the Affordable Care Act, which relies on the program for approximately half its coverage gains. The concern is that Republicans, stung by the backlash to their Medicare changes, will use the debt ceiling as leverage to force deep cuts, if not the substantial structural reforms they originally proposed, to the Medicaid program. And the administration hasn’t really ruled those out.

“Republicans establish their principles clearly and defiantly,” says Rockefeller. “That’s always been more of a problem for Democrats. The words that drive me crazy lately are ‘Republicans won’t let it happen.’ How is it Republicans are able to say no tax increases, no revenue increases, whatsoever? How is it that the famous five-story building in the Cayman Islands with 150,000 business headquarters is okay?”

“If they do a number on Medicaid, and don’t do anything on defense or revenues or loopholes for oil companies, I’m just not sure how good I’m going to feel about the debt ceiling vote. On a vote that big, you care about the future of the country and the world, but I want some people to know that I’m capable of watching out for my own people and my own conscience even at peril to some very important things. If they have me in the automatic yes column, maybe I don’t belong there.”

But surely, I asked Rockefeller, there must be some changes to Medicaid worth making. The program is much leaner than people give it credit for and its growth rate is below both Medicare and private insurance, but no program is perfect. “I’m not going to answer that yet,” he replied. “We’re beginning to coalesce. You can feel it. Chuck Schumer’s being very helpful on all of this, and I think it’s going to start yielding some results.”