Clinton’s Strategy: Reframing Medicaid as a Middle-Class Program

We are delighted to welcome the following guest post from Eric M. Patashnik of the University of Virginia


One of the key strategic moves that Bill Clinton made in his convention speech was to draw attention to the GOP’s plans to block grant Medicaid, which has been overshadowed by the debate over Medicare reform. As Peggy Noonan writes, Clinton gave Obama. “…one great political gift: He put Medicaid on the table. He put it right there next to the pepper shaker and said Look at that!”  Medicaid is often thought of as a residual welfare program for the poor, but as Clinton pointed out, it is also a vital safety-net for middle-class families.  ”Almost two-thirds of Medicaid,” Clinton said in his prepared remarks, is “spent on nursing home care for seniors and on people with disabilities, including kids from middle class families, with special needs like Downs syndrome or Autism.”

This is not the first time that Clinton has sought to recast Medicaid as a core middle-class entitlement. Back in his 1995 budget showdown with the Gingrich Republicans, Clinton rallied the public against the GOP’s proposed cuts in “Medicare, Medicaid, Education and the Environment.” As Colleen Grogan of the University of Chicago and I have argued (pdf, non gated), until the 1995 budget battle, “No other president had claimed that Medicaid, or any other means-tested program for that matter, carried the same importance as Medicare, whose political standing among both the public and policy elites was rivaled only by Social Security.”

Clinton went to great lengths in 1995 to distinguish Medicaid from welfare. He stressed that many of the seniors receiving Medicaid long-term care benefits had previously been hard-working, middle-class taxpayers before they got sick, and that they had middle-class children and grandchildren.  The media picked up on Clinton’s rhetoric.  Based on a LexisNexis search of national desk stories, Grogan and I identified 23 New York Times articles in 1981 (another period when Medicaid spending was under attack from the GOP) and 58 articles in 1995 that contained an explicit characterization of the Medicaid population. Virtually all the stories (96 percent) in 1981 described the Medicaid program as simply for “the poor”, even though there was already substantial middle class reliance on Medicaid at that time. A much smaller proportion (47 percent) did so in 1995.

Source: Colleen M. Grogran and Eric M. Patashnik. “Universalism within Targeting: Nursing Home Care, the Middle Class, and the Politics of the Medicaid Program” Social Service Review, 77(1): 51-71, March 2003.
It will be fascinating to see whether middle-class reliance on Medicaid emerges as a major campaign issue this fall.

4 Responses to Clinton’s Strategy: Reframing Medicaid as a Middle-Class Program

  1. Jack September 8, 2012 at 7:32 am #

    The Medicaid benefit for children with disabilities is vitaly important to those families that neeed. Often these children are very sick, requiring numerous doctor’s visits and hospitalizations. Even with good medical insurance these costs can run in to the thousands of dollars year after year. This is in addition to medical supplies and therapy that health insurance will not cover.

  2. Ted Anagnoson September 8, 2012 at 9:12 pm #

    I worked in the Department of HHS from 1995 to 1997 and spent a lot of time wondering why it was that Medicaid made it and AFDC did not – one factor that has impressed me is the client mix, which ties right in to Prof. Patashnik’s point, AFDC and the three old welfare programs (for the Aged, the Disabled, and the Blind) used to be considered together – but in 1973 we formed SSI, which included “the deserving poor” groups of aged, disabled, and blind, thus leaving politically isolated the welfare group, mostly “moms and kids” as the HHS people used to like to say.
    Medicaid, on the other hand, had everyone together, and most of the money went for the aged and disabled, including all those people in nursing homes and other forms of long-term care whose costs, in part, would be borne by their children if Medicaid didn’t cover them.
    It certainly seemed to make a difference to me, and since my father has been on Medicaid in Boston in a nursing home since 2002 (he’s now 96), I am even more conscious of what a difference Medicaid makes.

    Ted Anagnoson

  3. Josh McCabe September 9, 2012 at 1:03 pm #

    I’d love to hear more on how Clinton was successfully able to re-frame medicaid in light of sociologist Brian Steensland’s work on “symbolic pollution” in welfare programs when policymakers try to blur the line between “deserving” and “undeserving” poor.

  4. Carly EngageAmerica September 11, 2012 at 2:24 pm #

    An obvious reform is to block grant Medicaid funds to the states. This would grant them greater flexibility in tailoring Medicaid offerings to their state’s specific needs, and would place the onus upon the states to limit spending.