The Republican budget proposed by Rep. Paul Ryan (R-WI) would dramatically reduce access to care for millions of Americans by repealing the Affordable Care Act, turning Medicare into a “premium support” system that could make costs skyrocket, and switch the current Medicaid payment plan to a system of insufficient block grants. When it comes to Medicaid, however, not everyone is sure that budget goes far enough.

In an issue brief released last week, the conservative Heritage Foundation called for “transitioning” Americans out of Medicaid and “into more popular private health insurance options.” While the brief praised the block grant proposal from Ryan as an “important change,” it made clear that, in their view, even more action was needed:

The House Republican budget took important steps with regard to Medicaid by calling for the repeal of Obamacare and putting Medicaid on a budget. However, this is just a down payment on what needs to be done. The next—and equally as important—step is to put policies in place that restructure the Medicaid program so that low-income individuals and families are mainstreamed out of Medicaid and into the private health insurance market. In this way, Congress can expand the private insurance market, ensure more robust competition, and secure the kind of care that the vast majority of working Americans have today. At the same time, Congress needs to restore Medicaid to a true safety net program for the most vulnerable in society.

What Heritage did not say in their brief is that Medicaid actually costs less than private insurance. According to Families USA, it costs 20 percent less for Medicaid to cover lower-income Americans than private health insurance plans, which may not cover all the services those people need. And a study from the Kaiser Family Foundation released last week found that the rate of growth in Medicaid spending was actually lower than for private insurance plans.

Ryan’s block grant plan would cut federal spending on Medicaid by a third, dramatically reducing access to care and costing 14 million people access to care. If the Affordable Care Act was repealed, as Heritage and Paul Ryan both call for, the private insurers the brief suggests take over could also deny those people coverage because of a pre-existing condition. Under this plan, the “most vulnerable” Americans Heritage claims to be worried about would suffer.

-Zachary Bernstein

Six years ago today, Mitt Romney signed his health care reform bill into law, proclaiming during an elaborately staged signing ceremony at Boston’s Faneuil Hall, “Of course the bill isn’t 100 percent of what anyone in this room wanted.” “But the differences between us are relatively small.”

Romney thanked the Bush administration for approving federal authorizations to fund the law and praised the late Sen. Ted Kennedy (D-MA) for his “essential” work in shaping and advancing the bill through the state legislature. “Special thanks as well to the Heritage Foundation,” Romney continued. “Two of its leading scholars are the ones who helped design and craft what we now call the Connector, which is the centerpiece of the insurance reform portion.” Once Heritage’s Dr. Robert Emmet Moffit took the stage, he praised the law for establishing a new “patient centered” and “consumer-based” market where everyone can find affordable coverage:

MOFFIT (HERITAGE FOUNDATION): We’ve been honored by your request…to participate in giving our best advise and our technical assistance in designing a new and different kind of health insurance market. A market that is patient-centered and consumer-based, which will ease access to affordable coverage for thousands of Bay State citizens. This is new. It’s a new market, where individuals and families will be able to own and control their health insurance and take it with them to from job to job… Nothing like it has ever been attempted anywhere else in the United States. So Massachusetts has raised the bar for every state in the union. And that’s the applause you’ve given to your public officials here today is going to echo far beyond the hallow halls of this historic place.

Watch it:

Since its enactment, health insurance coverage among nonelderly adults in Massachusetts increased to near universal levels, nonelderly adults were more likely to have a usual place to go when they were sick, the state has reported drops in the shares of adults reporting a hospital stay and using the emergency department and seen gains in the affordability of care. More businesses are now offering health insurance and almosts all children can now see a doctor when they need to.

In fact, a new report released yesterday found that “for the second year in a row, the Massachusetts Health Connector’s Commonwealth Care program will provide private health insurance to eligible residents at a lower cost than the previous year.” The state will “save the state approximately $91 million with no benefit reductions or member co-pay increases” as a result of “contract renegotiations with providers and referral management,” said Commonwealth Health Insurance Connector Authority Executive Director Glen Shor. “Several of the insurance carriers achieved significant success in persuading provider organizations to serve Commonwealth Care members at a lower cost.”

According to a WBUR poll from February, 62 percent of Massachusetts residents support Romney’s law, while just 33 percent oppose it.

Our guest blogger is Paul Breer, a former ThinkProgress intern.

The Heritage Foundation’s website declares that the individual mandate “violates personal liberty” and is “inherently at odds with the original vision of the Framers,” but they conveniently forget to mention that the individual mandate was actually their idea. In 1989, the Heritage’s Stuart M. Butler gave a lecture titled “Assuring Affordable Health Care for All Americans.” Stuart’s lecture disclosed Heritage’s plan to reform the health care system, which called for an individual mandate:

If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services – even if that means more prudent citizens end up paying the tab.

Many states now…require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement…Mandate all households to obtain adequate insurance.

Even Newt Gingrich admitted in the Republican debate on Oct. 20 that the individual mandate originally came from the conservative Heritage Foundation. In fact, many Republicans in the 1990s, including Charles Grassley (R-IA), Orrin Hatch (R-UT), Bob Dole (R-KS), and Richard Lugar (R-IN), supported a national requirement for health insurance. As ThinkProgress’ Igor Volsky writes, many of the GOP presidential candidates have supported the individual mandate, including Romney, Gingrich, Huntsman, and former candidate Tim Pawlenty.

Showing just how far to the right the Republicans have moved, the Heritage Foundation originally touted the individual mandate as a way to help “those who need it most” and make the “health care industry as efficient and consumer sensitive as possible.” But now, from David Brooks calling his own Party not “fit to govern” to Pat Roberts calling the GOP field too “extreme,” Republicans are moving so fast to the right that their own ideas can’t keep up.

Earlier this week, Sen. Orrin Hatch (R-UT) spoke about his efforts to repeal the Affordable Care Act before the conservative Heritage Foundation in Washington, DC. Hatch was introduced by Michael Franc the group’s vice president of government studies, who, in recalling the major provisions of the law, took a veiled swipe at the ongoing Occupy Wall Street movement.

Franc said that the health law’s provision permitting young adults to stay on their parents’ health insurance policies until age 26 was driving up health care premiums and suggested that its beneficiaries were slackers, akin to the Wall Street demonstrators:

FRANC: And that increase comes even as two coverage mandates are taking effect. One is to cover grown men and women up to age 26, many of whom are protesting at the Occupy Wall Street demonstrations, I might add. I was there this past weekend looking at it.

Watch it:

Hatch didn’t repudiate Franc’s characterization in his remarks, despite the fact that 1 million Americans have become insured as a result of the provision. Instead, the senator accused the demonstrators of possessing a “welfare mentality” that is “starting to pervade our country.”

Interestingly, while Hatch and Heritage now condemn health care reform, both Hatch and the Heritage Foundation had supported the individual mandate — a key provision of the law — before it was embraced by President Obama.