Medicaid in the GOP’s crosshairs

MEDICAID IN THE GOP’S CROSSHAIRS…. The Republican plan to effectively eliminate Medicare will certainly dominate much of the budget debate in the coming months, but let’s not overlook the significance of the GOP plan to gut Medicaid by turning it into a block-grant program.

House Budget Committee Chairman Paul Ryan (R-Wis.) wants Americans to think of his Medicaid plan as “welfare reform.” That’s politically clever, I suppose — most people have been conditioned not to like “welfare,” and to love “reform” — but as Matt Yglesias explained this morning, it’s a scam.

[P]eople are supposed to think Medicaid is that “bad” kind of government spending, the one that goes to shiftless black folks not hard-working Americans like you and me and Paul Ryan. […]

This is mostly a program for the elderly and the disabled. It’s the main way we finance long-term care in this country. If you don’t directly benefit from it, you very likely have a parent or grandparent who does and whose financial needs will simply tend to fall on you if the program is cut. Meanwhile, in terms of the “welfare” aspect of Medicaid by far the largest set of poor people it covers are poor children. Is Ryan’s view that these kids should have worked harder to have rich parents? Poor kids tend to struggle with a lot of problems and are in many ways disadvantaged in the competitive economy by the time they’re out of diapers. It seems to me that investing in their basic health care is a no brainer way of leveling the playing field somewhat and ensuring that the country is making the most of our human resources.

It is a no brainer unless you consider Ayn Rand’s silly novels an economic blueprint.

The key takeaway here is that House Republicans believe seniors, people with disabilities, and low-income children have had it too easy, for too long. It’s time to show these ne’er-do-wells some “tough love,” slashing their health benefits, and directing those funds where they belong — in the hands of millionaires and large corporations in the form of tax cuts.

Ezra Klein also had a good piece this morning, walking us through the practical consequences for the House GOP plan on Medicaid.

[P]erhaps cutting it wouldn’t be so bad if there were a lot of waste in Medicaid. But there isn’t. Medicaid is cheap. Arguably too cheap. Its reimbursements are so low many doctors won’t accept Medicaid patients. Its costs grew less quickly than those of private insurance over the past decade, and at this point, a Medicaid plan is about 20 percent cheaper than an equivalent private-insurance plan. As it happens, I don’t think Medicaid is a great program, and I’d be perfectly happy to see it moved onto the exchanges once health-care reform is up and running. But the reason that’s unlikely to happen isn’t ideology. It’s money. Giving Medicaid members private insurance would cost many billions of dollars.

That’s why it’s well understood that converting Medicaid into block grants means cutting people off from using it, or limiting what they can use it for…. There’s just not another way to cut costs in the program. You can, of course, work to cut costs outside of the program, either by helping people avoid becoming disabled or making it cheaper to treat patients once they become disabled or sick, but those sorts of health-system reforms are beyond the ambitions of Ryan’s budget.

One can try to rebrand cutting care for the elderly, people with disabilities, and low-income children as “welfare reform,” but that doesn’t change the callousness of the policy.