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Medicaid Cuts Far Deeper in Republican Plans, But Those Would Hit Seniors As Well

You cannot really divorce the Romney-Ryan plan for Medicare with their plan for Medicaid. The simple reason for this is that Medicaid is the leading provider of long-term care for seniors. Six million seniors, in fact, get their nursing home care from Medicaid. Dual eligibles would lose the ability to access Medicaid benefits for this purpose if the program, as Mitt Romney and Paul Ryan favor, gets converted into a block grant.

Ryan has proposed scaling back the nation’s four-decade-old insurance program for the poor and disabled — bringing down the cost by $810 billion over 10 years. The measure is part of a budget he has said aims to avert “an epic collapse of our health and retirement programs that would devastate our nation’s most vulnerable citizens.”

Ryan, who chairs the House Budget Committee, also wants to give states their Medicaid contributions in “block grants,” or set amounts, each year. States would get more flexibility, with the expectation that they would be able to use the money more efficiently and creatively.

But experts say the cutbacks are so dramatic that it would be impossible for states to innovate their way out of massive cuts to a program that in 2010 served some 54 million Americans, roughly 6 million more than Medicare. “There’s always great interest on the part of Republican governors and conservatives in block-granting Medicaid, and it is always framed as a debate about flexibility. But it never is,” said Drew Altman, president of the nonpartisan Kaiser Family Foundation. “Really, it is all about money.”

Basically, well-off seniors wouldn’t experience immediate cuts through Medicare, thanks to the screen that keeps the program intact for those 55 and over (although their risk pool would shrink and quality would suffer over time). But poor seniors are fair game for immediate reductions. And the disabled, 11 million of whom use Medicaid benefits, get screwed as well.

It’s impossible for $800 billion in Medicaid cuts, the level in the Ryan budget, to hit something other than enrollment. And since long-term care is the most expensive part of Medicaid, they’d be first in line.

Once again, we have a case where the Republican nominee refuses to get specific about his plans. Romney has supported the concept of a block grant for Medicaid, which would effectively and dramatically reduce funding for the program. But he won’t say specifically how much he would reduce the funding, and how much it would diverge from the rise in health care costs over time.

The Urban Institute looked at the 2011 Ryan Plan for block granting, and found that between 14 and 27 million Medicaid beneficiaries would lose their coverage by 2021. Here we have a real difference of in policies, as Medicaid gets expanded under the Affordable Care Act to cover 16 million more Americans, up to 133% of the federal poverty line. Thanks to the Supreme Court ruling make it voluntary for states in accepting the ACA expansion, many states will resist that Medicaid expansion.

Romney and Ryan may think that nobody sees the invisible poor, that they don’t vote, and so you can take away their coverage with impunity. But the millions of seniors who would be directly affected al have kids, who understand that without a long-term care benefit in Medicare, Medicaid has become the only option for caring for their loved ones when they’re most vulnerable. Medicaid touches far more lives than politicians think.

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David Dayen

David Dayen