The lede of the Boston Globe’s campaign story a few days ago was explicit:
Republican presidential candidate Mitt Romney yesterday called on Congress to take money from Medicaid, not defense, to compensate for the failure of the congressional supercommittee to agree on deficit reductions.
Romney on the campaign trail in New Hampshire was explicit, too. He challenged the president to rescind the defense spending cuts that will occur automatically as a result of the supercommittee’s inability to strike a deal. Where will the budget savings come from if defense spending stays put? According to Romney’s plan, budgeters will pull it from Medicaid, the state-federal health program for the poor—and the middle class, when they need long-term care. “Return that program to the states,” Romney argued. If you tell the states, some of which have been struggling to pay for their share of the Medicaid program, that their funding would grow at a rate relative to the consumer price index, “you more than compensate for the $600 billion that you restored to the defense budget.” Peter, meet Paul.
Mind you, the candidate was talking to employees of BAE Systems, a big defense contractor, so the idea of no defense cuts must have appealed to the workers who heard Romney’s message that cutting the military at a time when the world has become more dangerous is not acceptable. But anyone reading the Globe’s report and wanting to know about the guns-for-health swap would not have been so clearly informed.
The Globe story missed a chance to let readers in on what cutting Medicaid really means, and for whom. Instead we learned a bunch of stuff that did not connect with the Medicaid part of the lede. We now know the Associated Press said that Obama has actually increased the defense budget, and the paper gave some numbers to support its point. Perhaps it’s easier for a reporter to quote another news outlet than write about Medicaid intricacies. The Globe also told readers that “Romney listed several programs that Obama wants to eliminate, for example, the development of a long-range bomber for the Air Force,” apparently trying to inject some conflict into the story mix. That’s an all-too-typical and predictable tactic for campaign stories.
No one, though, touched on the controversy and conflict that will ignite over radically changing Medicaid. Readers do know that Congressman Charlie Bass, a New Hampshire Republican, “threw his weight behind Romney,” but the two do not see eye-to-eye on the supercommittee. The reporter asked Bass about this, and he replied that Romney has the qualifications, leadership ability, and experience to be a good president. The reporter did not appear to have asked Bass whether he supported Romney’s major message that day—taking money from Medicaid to feed defense. At this point near the end of the piece, Medicaid was lost.
As Romney’s candidacy unfolds, no doubt he and others will talk about how Medicaid gobbles up too much of the federal budget. The way to trim Medicaid spending appears to be block-granting it—or giving a set amount of money to the states and letting them divvy it up among poor people who need health care. It will be tempting for reporters to slip into the journalistic shorthand term “block grants” without telling their audiences what they are.
Earlier this year, Mary Agnes Carey and Marilyn Werber Serafini of Kaiser Health News took a crack at explaining how Medicaid block grants would work, and how they would ultimately cut federal spending for Medicaid. They pointed out that everyone who is eligible and meets certain requirements for income and assets is guaranteed a spot in the program. The feds pay sixty percent of the cost, and in return the states must cover certain groups of people, like children and pregnant women, who meet the rules. “A block grant would effectively end this open-ended approach and provide states with annual lump sums,” they wrote. “States would be freer to the run the program as they wanted.” That means, of course, they can drastically cut the number of people eligible, leaving them without the ticket to health care.
Reporters covering the candidates who really want to do a good job need to dust off the Kaiser story. Medicaid will be a hot button topic for months to come. As Carey and Werber Sarafini pointed out, health reform will mean several million people brought onto to the Medicaid rolls. Plus, they said, the debate over Medicaid gets to the core of the social contract between the government and its citizens. What kind of country do we want?
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.