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Medicaid has become a key component in negotiations over the debt ceiling


About 1 out of every 4 Americans gets their health care coverage through Medicaid. The federal program that mainly serves people with lower incomes or disabilities has become pivotal to negotiations over the debt ceiling. Republicans want to make more people work to qualify. Many Democrats say that's a nonstarter. Let's ask Democratic Representative Pramila Jayapal of Washington state about this. Congresswoman, President Biden says making it harder for anyone to get Medicaid is off the table. Is that something you agree with?

PRAMILA JAYAPAL: We agree that work requirements do not have any good effect. We've actually found that when they've been instituted, particularly after the drastic social safety net cuts of 1996, five years later, there was no difference in employment rates among those recipients. And they tend to hurt the very people they're intended to serve.

MARTÍNEZ: States - some states try to make their own rules when it comes to Medicaid. Arkansas has attempted to tie benefits to work requirements. A recent referendum in Wisconsin supported that idea. Should states be able to make their own rules on Medicaid?

JAYAPAL: You know, I really don't think that they should. I think we should try to control this from the federal level, because what we see is that the cuts to Medicaid - the states that don't choose to take on Medicaid recipients or choose to institute these kinds of heavy burdens are the ones that are suffering the most for the people that need it the most. So I think we should have consistent Medicaid requirements across the country. They should be dictated by the federal government. And, you know, I think ultimately we want to make sure we're helping people, not hurting the very people that need it the most.

MARTÍNEZ: Even if states pick up a part of the cost. It's a jointly funded program.

JAYAPAL: Well, that's the problem. I think, because we've made it a jointly funded program, unlike Medicare, states do feel like they have the ability to put in their own rules. I think over time - and obviously this isn't something we can accomplish right away, but I think that is one of the flaws of this very important Medicaid program, is we give states too much control over helping the neediest people in their states.

MARTÍNEZ: If Republicans are successful and more requirements for work are tied to benefits such as Medicaid or SNAP - that's the program that provides aid for groceries - how would it affect states like yours, Washington?

JAYAPAL: Well, Washington state - you know, we are a Democratically controlled state, and so we have much fewer burdens in place. But I have to say, this cannot be a negotiating point on the table. I do not think that Republicans can win on this. And some Republicans themselves have said that this doesn't actually do anything to cut the deficit. So let's be clear that, you know, the amount of money that would be saved is extremely little, if anything. These work requirements require huge administrative burden. I've talked to the people who administer these programs, and they say they have to spend a lot of money just to have people go through and determine whether or not somebody is eligible, whether or not the work requirement actually fits the condition. A lot of people who are on these programs are cycling in and out of different jobs. They're often low-wage workers. They often don't have the stability that a lot of others may have. And so work requirements are just an administrative burden that costs a lot of money and, again, do not help in terms of getting more people back into employment.

MARTÍNEZ: Congresswoman, you used to be on the House Budget Committee. Do any arguments at all from the GOP about lowering spending hold water for you, any at all?

JAYAPAL: Well, I think the key thing here is we have to think about the difference between debt and deficit. If Republicans want to talk about the deficit, we have shown through the last two years of the Biden administration and the bills that we've passed that we can reduce the deficit by raising revenue. And that is the thing that is consistently very hypocritical about the Republican position on this, because they don't want to raise revenue. In fact, they often ensure that their tax cuts go to the wealthiest and don't actually bring in money, whereas Democrats are willing to talk about the fact that the deficit can be reduced by increasing revenues. And I think that's a very important thing at the end of the day.

MARTÍNEZ: Just a few seconds left, Congresswoman - what's going to have to happen to make this deal happen?

JAYAPAL: We've got to have a clean debt ceiling. That is the first thing. We've got to raise the debt ceiling in a clean way. Democrats have a discharge petition to do this. I think we are going to have to put everything on the table, including potentially using the 14th Amendment, because Republicans cannot be rewarded for hostage-taking, trying to get extreme ideas in that they couldn't get in even in the budget negotiations that happen every year.

MARTÍNEZ: That's Democratic Representative Pramila Jayapal. Thank you very much.

JAYAPAL: Thank you. Transcript provided by NPR, Copyright NPR.

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