Bill Clinton covered a lot of ground in his policy-rich speech at the Democratic Convention last night. But one under-appreciated issue he brought to the fore was the identical plans Mitt Romney and Paul Ryan have put forward for Medicaid — which provides health coverage for seniors, the disabled, and low-income families — and how they would decimate the program:
They also want to block grant Medicaid and cut it by an third over the coming ten years. Of course that’s gonna really hurt a lot of poor kids. But that’s not all. Lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid… And a lot of that money is also spent to help people with disabilities. Including a lot of middle class families whose kids have down syndrome or autism or other severe conditions.
To fill in the details on Clinton’s points:
Romney and Ryan’s Medicaid cuts plans are worse than their Medicare cuts. Their proposal to privatize Medicare with a premium support system doesn’t kick in for a decade, and even then Ryan’s growth path for the program would be the same as Obama’s. Their cuts to Medicaid, by contrast, start immediately and cut the program 35 percent by 2022 — a loss of $810 billion over that time period. And that excludes their repeal of Obamacare’s Medicaid expansion, which cuts out hundreds of billions more.
Their cuts hurt current seniors. Clinton misspoke here. 38 percent of Medicaid spending goes to 9 million Americans who are “dual eligibles” for both Medicaid and Medicare, but a good portion of them are non-elderly Medicare beneficiaries. But 1.9 million of Medicare’s seniors rely on Medicaid for long-term care, and would immediately start seeing annual decreases in their benefits of around $2,500 due to the Romney-Ryan Medicaid cuts.
Their cuts hurt children and the disabled. As Clinton pointed out, Medicaid assists millions of American families with members suffering from mental and physical disabilities. Half of the program’s 63 million enrollees are children, and rural children are particularly at risk: according to Erik Stegmen, Manager of CAPAF’s Half in Ten Campaign, rural children have less access to private insurance than urban children, rely on Medicaid more, and an expansion of the program decreased the rate of uninsured rural children from 21 percent in 1997 to 9 percent in 2005. Medicaid even provides help with 40 percent of all maternity stays. All these benefits would come under Romney and Ryan’s knife, leaving millions of vulnerable Americans with no obvious alternatives.
They block grant Medicaid. This move would shift Medicaid’s costs to state budgets, leaving them to shoulder any added demands on the program alone. It could also allow right-wing state governments to undo benefits currently required by the federal government. The counter claim by Romney, Ryan and their defenders is the states’ newfound freedom will lead to greater efficiencies in the program. This is wildly improbable. Medicaid’s reimbursement rates to providers are already as lean as they get — about one third lower than Medicare’s. The Centers for Medicare & Medicaid Services found that in 2011, Medicaid made $21.9 billion in improper payments, or a bit under 10 percent of its budget for that year. Eliminating all of this waste would still leave Medicaid well short of making up a loss of one third of its budget, much less getting anywhere close to Medicare’s reimbursement levels. And if the cuts don’t come out of reimbursement rates then they’ll probably come out of enrollment, kicking 14 to 27 million people off the program. (The repeal of Obamacare’s Medicaid expansion would end coverage for an additional 17 million or so.)
In sum, Romney and Ryan’s plans for Medicare, misguided as they are, are far less draconian and radical than their plans for Medicaid. Bill Clinton did the country a service by highlighting the latter in his speech last night.