Another Reminder: Medicaid, Not Medicare, Biggest Target For Conservatives

At the risk of sounding like a broken record on this subject, I devoutly hope that in their rush to tie Mitt Romney to Paul Ryan’s Medicare proposal, progressives don’t forget that there has never been much space between the two running-mates on the national health care program Ryan’s budget would really destroy: Medicaid. Wonkblog’s Suzy Khimm has a reminder today:

Paul Ryan’s Medicare overhaul may be the most controversial part of his budget.But the proposed cuts to the program are not the biggest cuts in the plan.

As Ezra notes, Ryan’s cuts to Medicare “are only 60 percent as large as the cuts to Medicaid and other health-care programs.” What’s more, his biggest change to Medicare wouldn’t kick in until 2023—the start date for his voucher-based premium support program. By comparison, Ryan’s cuts to Medicaid are more drastic, and they start sooner: Between 2013 and 2022, it would make nearly $1.4 trillion in cuts to Medicaid that “would almost inevitably result in dramatic reductions in coverage” as well as enrollment, according to the non-partisan Kaiser Family Foundation.

Over the next 10 years, the Ryan plan would cut Medicaid by $642 billion by repealing the Affordable Care Act and by $750 billion through new caps on federal spending—a 34 percent cut to Medicaid spending over the next decade, according to Edwin Park of the Center and Budget and Policy Priorities.

Who would that impact? First, by overturning the ACA, the Ryan plan would prevent 11 million people from gaining Medicaid coverage by 2022, according to the Congressional Budget Office’s latest estimates….

If states maintained their current level of spending for each Medicaid patient, 19 million more people would have to be cut from the program in 2021 because of Ryan’s block-grant reform, according to the Kaiser Family Foundation. If states managed to curb health-care spending growth in Medicaid, 14 million beneficiaries would still lose Medicaid coverage under the Ryan plan. And that’s on top of the 11 million Americans who would lose Medicaid coverage because the Ryan plan would repeal Obamacare. So all in all, Ryan’s cuts could mean as many as 30 million Medicaid beneficiaries lose their coverage.

Yeah, yeah, I know, old folks vote and in the last two cycles a majority have voted Republican, and po’ folks don’t vote so much, and far more already vote Democratic. But Lord a-mighty: 30 million people potentially losing their health insurance because Romney and Ryan think they need to show more moral fiber. Given Romney’s support for the entire Ryan Budget, that doesn’t even get into the damage wreaked on efforts to help the poor escape from total dependence on cash assistance or private charity by the combined cuts to Medicaid, food stamps, and the earned income tax credit that budget contemplates. And on top of all that, many millions of indigent seniors depend on Medicaid for nursing home care.

So before progressives decide to devote all their time to endless arguments over exactly which term to use for what the Ryan Budget proposes to do to Medicare–vouchers, cost-shifts, abandonment, abolition-of-Medicare-as-we-know it–don’t forget about Medicaid. That’s the Great Society safety net program with the biggest bullseye painted on it.

Ed Kilgore

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.