On Friday, the Florida legislature passed two bills that would shift hundreds of thousands of poor and elderly beneficiaries in Medicaid onto private HMOs and “other types of managed-care plans.” Under the proposal — which Gov. Rick Scott (R) is expected to sign — seniors with long-term care needs would be required to enroll in private health coverage by October 2013 and women and children would have to begin participating in October 2014. Beneficiaries with developmental disabilities would be excluded from the requirement.

Proponents claim that the change would “hold down spiraling costs in the $20 billion program, while also improving a fragmented system of care.” But the date is far less conclusive. In fact, a five-county Medicaid pilot program that tested the idea of whether “privatization would save the state money while improving services” found widespread complaints and little evidence of savings. From an analysis by Georgetown University:

This study concluded that the pilots were saving money, but did not account for the cost of the enhanced benefits program and increased administrative costs associated with the pilot.

The study also concluded that it was not possible to assess whether these savings were a result of reduced access to care or more efficient provision of services. … Much critical information is still lacking about the impact of Florida’s Medicaid pilots, including whether or not the pilots have saved money – and if they have whether the savings came at the expense of needed care. [...]

Market instability and plan turnover have resulted in significant changes in beneficiary plan assignments over the past three years, which is likely to have caused disruptions in care for children, people with disabilities and other vulnerable populations.

Other cash strapped states are strongly considering partnering with private insurers, but the evidence on the degree to which managed care actually accomplishes these goals varies. Medicaid patients in some states seem to have better access to doctors, while other surveys have found that overall improvements in access associated with managed care are minimal.

States view managed care as way to reduce their Medicaid expenditures, but they have to ensure that private payers aren’t looking out for short term profits by denying treatments or reducing reimbursement rates. Florida’s expansion of managed care — which still has to be approved by the federal government — will serve as a test of that criticism, even if the results of its pilot program are already less than promising.

Rep. Paul Ryan (R-WI) is clearly a pretty smart guy, but one of his greatest assets is his perceived earnestness, sincerity, and honesty. During his 19 Easter town halls in Wisconsin, Ryan charmed the crowds into agreeing that our entitlement spending was out of control and that his plan — while maybe not the perfect solution — represented a brave step forward towards balancing the federal budget. In doing so, he convinced almost everyone to at least consider his proposal as a starting point for negotiations.

ThinkProgress — which attended many of these meetings — reported that in making his case, Ryan routinely side-stepped the real concerns of his constituents by relying on platitudes and outright misrepresentations of his plan and now FactCheck.org has found that he used on the same sleight of hand in a series of “Setting The Record Straight” web posts on his website:

- Ryan says Obama’s proposed budget “commits seniors to bureaucratically rationed health care.” In fact, the new health care law states that the advisory board to which Ryan refers “shall not include any recommendation to ration health care.” Furthermore, the board members are to be primarily doctors, economists and other outside experts, not Washington bureaucrats.

- He says that closing the Medicare prescription drug coverage gap would “increase prescription-drug prices for everyone.” But the Congressional Budget Office says out-of-pocket costs would be unaffected or lower for many.

- He claims the health care law doesn’t improve Medicare’s finances. Not true. It does, but experts worry some cost controls won’t be fully implemented. Furthermore, Ryan’s budget keeps in place some of those same cost controls.

- A GOP document defending Ryan’s plan wrongly claims that the budget “does not cut Medicaid” and that it “spends more on Medicaid each year than it does the previous year.” That’s false. Ryan’s own projections call for slashing Medicaid below this year’s spending level for years to come.

During his town hall meetings, the Ryan was routinely challenged by his constituents on his plan to lower tax cuts for the rich and transform Medicare into a “premium support” system in which seniors received a pre-determined sum of dollars to purchase health coverage from private insurers. Wisconsinites pressed Ryan on why the money used to extend the Bush tax cuts wasn’t being applied to the deficit, why their children would not receive the same guaranteed Medicare benefits that they’ve enjoyed, and why the government’s “premium support” did not keep up with medical inflation.

Ryan usually dismissed these concerns by saying that repealing the Bush tax cuts would only negligibly affect the national debt and by insisting that the biggest threat to Medicare was doing nothing at all. He also disingenuously claimed that the GOP’s “premium support” proposal was almost identical to the coverage he receives as a member of Congress, repeated the debunked notion that Medicare would not change for Americans over 55 years of age, and incorrectly said that he would not cut the current Medicare program.

Jonathan Chait has a good piece on how this Washington Post editorial sets the conventional wisdom about entitlement reform, shielding Rep. Paul Ryan (R-WI) from any serious criticism about the consequences of his plan. It’s as if having a plan is actually more important than the substance of the actual proposal or as Chait puts it, “The need to do something is deemed so overwhelmingly vital that it’s immoral to criticize any plan that does something, however harmful or poorly designed that something may be.” In that vein, the Post editorial goes after HHS Secretary Kathleen Sebelius for claiming during a recent Education and Labor Hearing that more people might die under Ryan’s proposal:

Health and Human Services Secretary Kathleen Sebelius told a House panel that seniors would “die sooner.” The Democratic National Committee proclaimed in an ad: “Their leaders have called for cutting Medicare, and now for killing it.”

This is false, inflammatory and, as we said, useful — for winning elections, that is. When it comes to solving the government’s most pressing problem, it threatens to set things back.

But why is it false to argue that shifting more of the cost of health care coverage to seniors and strapping them with a depreciating health care voucher would make it harder for them to afford care and cause them to skip (or just not receive) life saving medical treatment? Forty-five thousand Americans die prematurely every year because they lack health insurance coverage — a number that would only grow if Ryan were to repeal most of the Affordable Care Act and transform the Medicaid program into block grants.

The Medicaid changes would contribute to the deaths of the poorest and most vulnerable. Ryan would get rid of the existing matching fund program — under which the federal government pays 50 to 75 percent of each state’s Medicaid costs — and give states block grants that are smaller than projected funding. As a result, states would have to make up the difference by increasing spending or (more realistically) capping enrollment, cutting eligibility, limiting mandatory benefits and lowering provider reimbursements. In fact, an analysis of Newt Gingrich’s 1995 block grant proposal concluded that had that plan been adopted, 48 states would have experienced a reduction in federal dollars and “more than 6 million people would have lost Medicaid coverage in 2002.” If all this wouldn’t cause people to “die sooner” than I don’t know what will.