Paul Ryan’s Moral Barbarism
Karl Rove’s column the other day joined the many conservatives expressing their hurt and anger that President Obama would depict Paul Ryan’s budget as harming sick and vulnerable citizens:
Mr. Obama likes campaigning more than governing. And for this president, campaigning means knocking down straw men and delivering a steady stream of misleading attacks. It means depicting opponents as indecent, heartless people who take special delight in targeting seniors and autistic children.
In fact, Obama has never accused Ryan, or anybody, of having a “special delight” in targetting seniors and autistic children. But he has accused them of pursuing policies that would harm, among others, seniors and autistic children. That’s because it’s incontrovertably true. The Center on Budget and Policy Priorities delves into the details of Ryan’s plan to slash Medicaid by more than a third over the next decade, and in half over the next two decades:
- Seniors: An overwhelming majority of Medicare beneficiaries who live in nursing homes rely on Medicaid for their nursing home coverage. Because the Ryan plan would require such deep cuts in federal Medicaid funding, it would inevitably result in less coverage for nursing home residents and shift more of the cost of nursing home care to elderly beneficiaries and their families. A sharp reduction in the quality of nursing home care would be virtually inevitable, due to the large reduction that would occur in the resources made available to pay for such care.
- People with disabilities: These individuals constitute 15 percent of Medicaid beneficiaries but account for 42 percent of all Medicaid expenditures, mostly because of their extensive health and long-term care needs. Capping federal Medicaid funding would place significant financial pressure on states to scale back eligibility and coverage for this high-cost population, many of whom would be unable to obtain coverage elsewhere because of their medical conditions.
- Children: Currently, state Medicaid programs must provide children with health care services and treatments they need for their healthy development through the Early Periodic Screening, Diagnostic and Treatment (EPSDT) aspect of Medicaid, which provides regular preventive care for children and all follow-up diagnostic and treatment services that children are found to need. A block grant would likely permit states to drop EPSDT coverage, meaning that children, particularly those with special health care needs, would not be able to access some care that medical professionals find they need (because Medicaid would no longer cover certain health services and treatments for children, and their parents wouldn’t be able to afford to pay for that care on their own).
- Working parents and pregnant women: Many state Medicaid programs already have extremely restrictive eligibility criteria for parents. In the typical state, working parents are ineligible for Medicaid if their income exceeds 64 percent of the poverty line (or $14,304 a year for a family of four), and unemployed parents are ineligible if their income exceeds 37 percent of the poverty line ($8,270 a year for a family of four). Under a block grant, states could cut these already low eligibility levels even further, cap enrollment, and/or require low-income parents to pay more for health services. States could do the same for low-income pregnant women who rely on Medicaid for their prenatal care, resulting in them forgoing services that are critical to ensuring a healthy pregnancy.
Now, Rove appears to be a pathological liar, or at least so deeply enmeshed in partisan spin it’s not clear that a distinction exists in his mind between objective truth and claims that are useful to his side. But many other conservatives have likewise expressed what has the ring of genuine outrage that Obama would accuse Ryan of snatching medical care away from people in nursing homes, very poor families, special needs children, and so on. I think it reflects, in part, an inability or lack of desire to think with any specificty about the concrete ramifications of imposing extremely deep cuts to Medicaid. Who do they think is on Medicaid? Prosperous, healthy people?
No, Medicaid is a bare-bones program throwing a lifeline to people who are in bad shape. Cutting Medicaid may be the politically easiest way for Ryan to clear budget room to preserve Bush-era revenue levels, as Medicaid patients have little political clout. But it is, well, deeply immoral. I’m actually surprised that conservatives not only can’t seem to imagine (or care about) the consequences of such policies, but they can’t even imagine that people like Obama would actually feel moral outrage at their plan. They can’t imagine a liberal objection as representing anything other than an attempt to score political points. It’s bizarre. I mean, of course Obama finds it morally objectionable to take away medical care to people in nursing homes and children with special needs. That’s why he’s a Democrat.
By: Jonathan Chait, The New Republic, May 3, 2011
Governor Walker’s Misleading Claims On Medicaid
Wisconsin Governor Scott Walker painted a misleading picture of Medicaid in his New York Times op-ed on Friday. Medicaid is neither obsolete nor inflexible and changing it to a block grant, as the House Republican budget that Walker supports would do, would significantly harm the millions of seniors, people with disabilities and children who rely on it every day.
Governor Walker says Medicaid is obsolete because it is biased toward covering people in nursing homes rather than their own homes. In fact, Medicaid is moving in precisely the opposite direction. In 1990, just 13 percent of Medicaid spending on long-term care went for care in the community rather than in an institution. By 2009, the figure was 43 percent. That’s a great example of how Medicaid is changing with the times.
Moreover, health reform, (i.e., the Affordable Care Act) provides several new options to speed this trend along and continues funding for the “Money Follows the Person” program, in particular, which moves people from nursing homes back to the community. With health reform’s new options and funding, progress will likely continue. That won’t happen under the House Republican budget plan, which would sharply reduce funding for Medicaid and convert the program to a block grant.
My colleagues, Edwin Park and Matt Broaddus, have shown how risky a block grant is for states. If the House Republican block grant proposal had been in place starting in 2000, their analysis shows, in 2009 Wisconsin would have received 40 percent less in federal funds – nearly $1.6 billion in that year alone. With such a sharp drop in federal funds, the state would have been ill-equipped to deal with a recession or even to meet the ongoing needs of an aging population.
Governor Walker claims the success of the Children’s Health Insurance Program (CHIP) and state Medicaid demonstration projects show that states could do well under a Medicaid block grant, but he’s wrong on both counts:
CHIP, which does operate under a structure similar to a block grant, has a narrower purpose than Medicaid, as noted in a recent brief from the Kaiser Commission on Medicaid and the Uninsured. It covers far fewer children than Medicaid and covers children in families with higher incomes. Moreover, in the past, some state CHIP programs did run short of funds and had to freeze enrollment and set up waiting lists.
As to Medicaid demonstration projects, they allow states to cover people who are ordinarily not eligible for Medicaid (such as low-income, childless adults) or services that aren’t usually covered (such as short-term, or “respite,” care for families with children with complex medical conditions) as long as they don’t spend more federal funds than they otherwise would have received. This is nothing like the Ryan block grant, which would slash the federal funds that states would otherwise get to help them run their programs, not hold federal funds steady.
By: Judy Solomon, Center on Budget and Policy Priorities, April 25, 2011
Tea Party Budgeting: Everyone Doesn’t Deserve A Fair Shot
Three lessons I’ve learned from Tea Party budgeting:
1. Charles Lightroller was a chump.
Lightroller was the second mate on the Titanic. Legend holds that no one enforced the command to allow women and children to board the lifeboats first more rigorously than he did. Some call him a hero. But not me. That’s because I, like Rush Limbaugh, think Paul Ryan’s budget is “wonderful.”
And how could you not? Ryan surveys the budget battlefield and here’s what he sees: on one side, an onrushing horde of seniors, working people, and the disabled. On the other, defenseless corporations and their affluent compatriots prancing like happy kittens amongst the flowers. In the face of such forbidding odds some might duck, but Ryan strides onto the field of play and bravely interposes himself between the conflicting parties, prepared to defend the defenseless come what may.
Here’s what that looks like: Medicare, the health program relied on by millions of seniors, is replaced with a benefit guaranteed to fall further and further behind the actual cost of healthcare. Medicaid (healthcare for people with low-incomes) sustains deep cuts. But tax rates on corporations and the highest earners are lowered, while subsidies for oil companies remain untouched. Truly a profile in courage.
2. Pell Grants are destroying America.
I feel badly for not recognizing it, but it seems so obvious now. Freeloaders figured out how to get free food, free housing, and free electricity years ago, but they’ve never been able to reach the Holy Grail: free Biology of the East African Mud Turtle 101. Until now. “You can go to school,” warns Rep. Denny Rehberg of Montana, “collect your Pell Grants, get food stamps, low-income energy assistance, Section 8 housing, and all of a sudden we find ourselves subsidizing people that don’t have to graduate from college.”
Welfare cheats scheming to take the college courses of their dreams? (And then not graduate!) It’s an outrage. How many of them are sitting in a college cafeteria right now snickering over a steaming plate of American Chop Suey? (Purchased with food stamps, natch.) “It’s turning out to be the welfare of the 21st century,” Rehberg says. Talk about getting schooled: that’s got to be one of the smartest theories I’ve ever heard.
Of course, it’s not just Pell Grants that are so nefarious. It’s Head Start too, and Medicare, and Medicaid, and …(hence, Lesson 1 above).
3. Better than Government? Fairies.
A signal question in American political life today is: when things go wrong, what role, if any, should government play in trying to make things right?
We seem to have settled on some answers. When we’re to blame for the bad things that happen, we’re on our own. The same is true when we do our best but lose fair and square. But what about when people encounter difficulties through no fault of their own and in a way that offends our sense of fairness? A kid who’s born into a family without the means to send him to a good school, or a mother who works hard every day but loses her employment because global economic forces are moving manufacturing jobs to other countries? Should government lend a hand in those kinds of cases?
The Ryans and the Rehbergs conceive of a government that does so less and less. They say the benefit of helping the disadvantaged is outweighed by its expense. What they don’t say is what happens to people who no longer can rely on needed government assistance. Perhaps magical fairies come along, wave their magic wands, and everyone who used to get a Pell Grant can still go to college, only this one is taught by chocolate bunnies! And all those people who can’t afford healthcare anymore? It’s OK. They’re now living in a cottage made entirely of gingerbread!
Let me be clear: there’s every reason to be serious about reducing the budget deficit. Political leaders on both sides of the aisle should be open to good faith ideas that emanate from anywhere on the political spectrum. But it’s reasonable to ask whether using concern over the deficit as an excuse to accomplish purely ideological goals can be considered serious.
Democrats agree that the private sector should be the engine that drives our economy and that we need the discipline to cut government programs that aren’t working. But there’s something else we believe that sets us apart from the Tea Partyers: there’s a promise inherent to the American free market system that says everyone deserves a fair shot, and that promise goes unfulfilled when people are disadvantaged by forces beyond their control and we all stand by and do nothing about it.
In other words, bring back Charles Lightroller. Boy, do we need him.
By: Anson Kaye, U.S. News and World Report, April 7, 2011
Cutting Medicaid Means Cutting Care For The Poor, Sick And Elderly
The part of Paul Ryan’s budget that’s going to get the most attention is his proposal to privatize and voucherize Medicare. But the part that worries me the most is his effort to slash Medicaid, with no real theory as to how to make up the cuts.
Ryan’s op-ed introducing his budget lists Medicaid under “welfare reform,” reflecting the widespread belief that Medicaid is a program for the poor. That belief is wrong, or at least incomplete. A full two-thirds of Medicaid’s spending goes to seniors and people with disabilities — even though seniors and the disabled are only a quarter of Medicaid’s members. Sharply cutting Medicaid means sharply cutting their benefits, as that’s where the bulk of Medicaid’s money goes. This is not just about the free health care given to some hypothetical class of undeserving and unemployed Medicaid queens.
But perhaps 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. You can see CBO director Doug Elmendorf say exactly the same thing here. 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.
To get around some of this, Ryan’s op-ed talks about state flexibility, with the implication being that states have some secret Medicaid policies they’ve been dying to try but that the federal government simply hasn’t let them attempt. But the truth is there’s been a tremendous amount of experimentation in Medicaid over recent decades. Indiana converted its Medicaid program into health savings accounts. Tennessee based its program around managed care. Massachusetts folded its Medicaid money into Mitt Romney’s health-care reforms. Oregon tried to rank treatments by value. Some of these reforms have worked well and some haven’t worked at all, but none have solved the basic problem that covering the sick and disabled costs money, and you can’t get around that by trying to redesign their insurance packages. For that reason, block-granting Medicaid ultimately means cutting health-care coverage to the poor, the elderly and the disabled, even as it doesn’t actually address the factors driving costs throughout the health-care system.
By: Ezra Klein, The Washington Post, April 5, 2011
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