“Dual Eligible’s”: Cut Medicaid And You Cut Health Care For The Elderly And Disabled
Gov. Romney and Rep. Ryan have been adamant that their Medicare proposals won’t affect people over 55. That may be true. But their Medicaid proposals sure will. A lot of health care for the elderly comes from Medicaid. We call those people “dual-eligibles”, because they qualify for both Medicare and Medicaid. Some dual-eligible are younger disabled people, but about two-thirds are 65 or older. The Kaiser Family Foundation reports:
Dual eligibles as a share of total Medicaid enrollees ranged from a low of 10 percent in Arizona and Utah to a high of 26 percent in Maine, due to demographic differences and policy preferences across the states. Similarly, spending on dual eligibles as a percentage of total Medicaid spending ranged from a low of 18 percent in Arizona to a high of 59 percent in North Dakota.
Lots of Medicaid money goes to the elderly. Cut Medicaid, and you likely cut some of that. Here’s more:
One quarter (25%) of Medicaid spending for dual eligibles went toward Medicare premiums and cost-sharing for Medicare services in 2008. Five percent of spending for duals was for acute care services not covered by Medicare (e.g., dental, vision, and hearing services). Another 1 percent of Medicaid dual eligible spending was for prescription drugs, a percentage that has fallen significantly since coverage for nearly all prescribed drugs for duals was shifted from Medicaid to Medicare Part D in 2006. The remaining 69% of Medicaid spending was for long-term care services, which are generally not covered by Medicare or private insurance.
That Medicaid money is going to Medicare premiums! It’s also going to actual care. Cut Medicaid, and you likely cut some of that.
It’s about time someone pointed that out. The health care proposals of Gov. Romney and Rep. Ryan will absolutely impact some elderly people way earlier than a decade. Unless they’ve changed their minds again.
By: Aaron Carroll, Washington Monthly Political Animal, September 7, 2012
“Making Medicaid Matter”: The Real-World Impact For Today’s Struggling Americans
Much of the 2012 policy debate, such as it is, has focused on Medicare, and with good reason — the Romney-Ryan plan to replace the Medicare system with a voucher plan is important and worth scrutinizing in detail.
But in his convention speech last night, Bill Clinton not only stressed Medicare, he also delivered a forceful reminder about the importance of Medicaid and what would happen to the program under Republican rule:
“Now, folks, this is serious, because it gets worse. And you won’t be laughing when I finish telling you this: they also want to block-grant Medicaid, and cut it by a third over the coming 10 years.
“Of course, that’s going to really hurt a lot of poor kids. But that’s not all. A lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid.
“It’s going to end [Medicaid] as we know it. And a lot of that money is also spent to help people with disabilities, including a lot of middle-class families whose kids have Down’s Syndrome or autism or other severe conditions.
And honestly, let’s think about it, if that happens, I don’t know what those families are going to do. So I know what I’m going to do. I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen.”
The future of Medicare is obviously important and should be a central issue in the presidential race, but as Matt Yglesias noted, “Medicaid is the one where much more is at stake on the ballot.”
Why? Because the Romney-Ryan plan, with a position they’re not at all bashful about, would block-grant Medicaid, leaving states with fewer resources, and leaving the poor and disabled in even more jeopardy.
Remember, unlike Medicare, Medicaid is a partnership between federal and state governments. The program undermines state budgets in a big way during economic downturns — more people begin to rely on the program and states, which can’t run deficits, struggle badly with the finances — and the moment a Romney-Ryan administration gives states the flexibility to do so, Republicans governors will start improving their finances by taking health care from the most vulnerable, who don’t exactly have lobbyists looking out for them.
What’s more, as Clinton reminded us, for all of Romney’s talk about leaving seniors’ benefits intact, the moment the GOP guts Medicaid, plenty of elderly Americans will feel the effects.
There’s no shortage of policy differences between the two major-party campaigns, but this is one of the more dramatic areas of disagreement, especially as it relates to the real-world impact of struggling Americans. Medicaid deserves to be an important part of the national debate, and kudos to Clinton for giving the issue the spotlight.
By: Steve Benen, The Maddow Blog, September 6, 2012
“Recreating The Great Depression”: Paul Ryan, John Galt, Gold And God
So far, most of the discussion of Paul Ryan, the presumptive Republican nominee for vice president, has focused on his budget proposals. But Mr. Ryan is a man of many ideas, which would ordinarily be a good thing.
In his case, however, most of those ideas appear to come from works of fiction, specifically Ayn Rand’s novel “Atlas Shrugged.”
For those who somehow missed it when growing up, “Atlas Shrugged” is a fantasy in which the world’s productive people — the “job creators,” if you like — withdraw their services from an ungrateful society. The novel’s centerpiece is a 64-page speech by John Galt, the angry elite’s ringleader; even Friedrich Hayek admitted that he never made it through that part. Yet the book is a perennial favorite among adolescent boys. Most boys eventually outgrow it. Some, however, remain devotees for life.
And Mr. Ryan is one of those devotees. True, in recent years, he has tried to downplay his Randism, calling it an “urban legend.” It’s not hard to see why: Rand’s fervent atheism — not to mention her declaration that “abortion is a moral right” — isn’t what the G.O.P. base wants to hear.
But Mr. Ryan is being disingenuous. In 2005, he told the Atlas Society, which is devoted to promoting Rand’s ideas, that she inspired his political career: “If I had to credit one thinker, one person, it would be Ayn Rand.” He also declared that Rand’s work was required reading for his staff and interns.
And the Ryan fiscal program clearly reflects Randian notions. As I documented in my last column, Mr. Ryan’s reputation for being serious about the budget deficit is completely undeserved; his policies would actually increase the deficit. But he is deadly serious about cutting taxes on the rich and slashing aid to the poor, very much in line with Rand’s worship of the successful and contempt for “moochers.”
This last point is important. In pushing for draconian cuts in Medicaid, food stamps and other programs that aid the needy, Mr. Ryan isn’t just looking for ways to save money. He’s also, quite explicitly, trying to make life harder for the poor — for their own good. In March, explaining his cuts in aid for the unfortunate, he declared, “We don’t want to turn the safety net into a hammock that lulls able-bodied people into lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.”
Somehow, I doubt that Americans forced to rely on unemployment benefits and food stamps in a depressed economy feel that they’re living in a comfortable hammock.
But wait, there’s more: “Atlas Shrugged” apparently shaped Mr. Ryan’s views on monetary policy, views that he clings to despite having been repeatedly, completely wrong in his predictions.
In early 2011, Mr. Ryan, newly installed as the chairman of the House Budget Committee, gave Ben Bernanke, the Federal Reserve chairman, a hard time over his expansionary policies. Rising commodity prices and long-term interest rates, he asserted, were harbingers of high inflation to come; “There is nothing more insidious that a country can do to its citizens,” he intoned, “than debase its currency.”
Since then, inflation has remained quiescent while long-term rates have plunged — and the U.S. economy would surely be in much worse shape than it is if Mr. Bernanke had allowed himself to be bullied into monetary tightening. But Mr. Ryan seems undaunted in his monetary views. Why?
Well, it’s right there in that 2005 speech to the Atlas Society, in which he declared that he always goes back to “Francisco d’Anconia’s speech on money” when thinking about monetary policy. Who? Never mind. That speech (which clocks in at a mere 23 paragraphs) is a case of hard-money obsession gone ballistic. Not only does the character in question, a Galt sidekick, call for a return to the gold standard, he denounces the notion of paper money and demands a return to gold coins.
For the record, the U.S. currency supply has consisted overwhelmingly of paper money, not gold and silver coins, since the early 1800s. So if Mr. Ryan really thinks that Francisco d’Anconia had it right, he wants to turn the clock back not one but two centuries.
Does any of this matter? Well, if the Republican ticket wins, Mr. Ryan will surely be an influential force in the next administration — and bear in mind, too, that he would, as the cliché goes, be a heartbeat away from the presidency. So it should worry us that Mr. Ryan holds monetary views that would, if put into practice, go a long way toward recreating the Great Depression.
And, beyond that, consider the fact that Mr. Ryan is considered the modern G.O.P.’s big thinker. What does it say about the party when its intellectual leader evidently gets his ideas largely from deeply unrealistic fantasy novels?
By: Paul Krugman, Op-Ed Columnist, The New York Times, August 23, 2012
“Terrifying Implications”: Texas Says “No Thanks” To Women’s Health Care
If you haven’t been worn down reading about Todd Akin’s bizarre and ignorant views about the female reproductive system, now turn to Texas, where women’s uteruses may soon have to move out of state to find health care. Late Tuesday night, a federal court of appeals ruled that Texas can exclude Planned Parenthood from the Women’s Health Program, which provides basic preventative care—like birth control and cancer screenings—for low-income women. The decision has terrifying implications in a state where women’s access to health care is already poor.
One in four women in Texas is uninsured, and the state also has the third-highest rate of cervical cancer in the country. In Texas, women’s health-care clinics serving low-income populations rely on two sources of funding: the Women’s Health Program and general state family-planning dollars. Lawmakers have attacked both streams.
In 2011, the state legislature slashed state funding for family planning—you know, the thing that prevents abortions—by two-thirds. A recent report from the Texas Observer revealed that 60 family planning facilities have already closed as a result of the cuts. While a full picture of the effect is still emerging, the Legislative Budget Board, a bipartisan committee, had estimated that when all was said and done, the cuts would lead to 20,000 additional births (which Medicaid would have to pay for). Projections show that around 180,000 women would lose health services.
Then there’s the damage to the state Women’s Health Program (WHP), a separate program that serves 130,000 low-income women. Created in 2005, the WHP is a crucial state service that provides preventative health care and family-planning services. It’s run through Medicaid, so the feds paid for 90 percent of the $40 million program. While it only serves women who are not pregnant, it saved around $75.2 million in 2009 by preventing a projected 6,700 births. The program seemed like a win-win; it decreased unplanned pregnancies and abortions, while increasing access to health care.
But the WHP may soon not exist, or at least not in a recognizable way. Lawmakers added new rules in 2011 that excluded Planned Parenthood from receiving funding. The trouble is, Planned Parenthood provided services to nearly half the women covered under the program and received about 25 percent of the program’s total funding last year. Barring the organization leaves many wondering whether those clinics left would meet demand.
Furthermore, the state violated federal policy by slashing Planned Parenthood funding, which means Medicaid can no longer foot the bill for the Women’s Health Program. Texas supposedly has a plan to transition to a state-run program by November 1; that plan will continue to exclude Planned Parenthood. The influential organization is fighting the state’s decision, and in October, the two parties begin court proceedings on whether Texas can permanently exclude the main provider of women’s health from its Women’s Health Program.
Yesterday’s decision means that between now and the court case, Texas can halt funding to Planned Parenthood clinics. It’s only a few months, but the clinics are already reeling from the family-planning cuts. The loss of WHP funding is a double whammy. Twelve Planned Parenthood clinics have already shut down, alongside the many clinics with no relation to the organization. Meanwhile, if the courts ultimately decide Texas cannot exclude Planned Parenthood from the WHP, the state may opt to shut down the program entirely.
Many, including the attorney general and Governor Rick Perry, celebrated the decision, and the state Health and Human Services Commission announced it would immediately halt funding to the group. Meanwhile, for the hundreds of thousands of low-income women in the state, there are fewer and fewer health-care options.
By: Abby Rapoport, The American Prospect, August 22, 2012
“Akin Unmasks The Pro-Life Movement”: “Slutty Women Will Do Anything To Avoid Facing The Consequences Of Their Actions”
The myth that women can’t get pregnant from rape stems from basic assumptions anti-choicers make about women.
If you’re going to slander the estimated 32,000 women a year who become pregnant after being raped, it’s probably not wise to do it on a Sunday, when it will lead the next week’s news coverage. Republican nominee for Missouri Senate Todd Akin chose not to follow this bit of wisdom, instead declaring in a television interview yesterday that women can’t get pregnant from rape.
“First of all, from what I understand from doctors [pregnancy from rape] is really rare,” Akin told KTVI-TV in an interview posted Sunday. “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”
For people who don’t follow the anti-choice movement closely, this statement might be a stunner for the simple reason that it makes no biological sense; a rapist’s sperm swims as well as a non-rapist’s. But for those of us who do, it’s no surprise. The myth that “real” rapes don’t result in pregnancy is widespread among anti-choicers—and not just the fringe (Akin, for instance, used to be on the board of Missouri Right to Life). You can see a variation of this myth at the anti-choice website Abortion Facts:
To get pregnant and stay pregnant, a woman’s body must produce a very sophisticated mix of hormones. Hormone production is controlled by a part of the brain which is easily influenced by emotions. There’s no greater emotional trauma that can be experienced by a woman than an assault rape. This can radically upset her possibility of ovulation, fertilization, implantation and even nurturing of a pregnancy.
Akin’s comment should serve as a reminder that despite its sentimentality surrounding the fetus, the anti-choice movement is motivated by misogyny and ignorance about human sexuality. In this case, what underlies the rape-doesn’t-get-you-pregnant myth is the notion that sex is shameful and that slutty women will do anything—even send an innocent man to jail to kill a baby—in order to avoid facing the consequences of their actions.
You can see this logic play out broadly in discussions about rape as well as abortion. The most common defense in rape cases is that the victim consented to sex and only “cried rape” in order to seem less promiscuous. The claim, of course, is nonsensical. Why would a woman trying to put a one-night stand behind her invite grilling by detectives and defense attorneys? Why would someone so concerned about maintaining the illusion of purity subject her sex life to examination by a crowd of jurors? That the myth persists nonetheless goes a long way to explaining why we have such low rape conviction rates. When it comes to abortion, anti-choice activists accuse women going into abortion clinics of taking the easy way out, as if raising an unwanted child is the rightful price of having sex.
While most everyone can see the absurdity of Akin’s comments, fewer pick up on the deeper problem of “rape exceptions” to abortion bans. When journalists and politicians refer to banning abortions except in the case of rape, they are assuming that there’s a way to construct abortion policy that allows women who “deserve” abortions to get them while preventing those dirty girls who consented to sex from having them. This is simply not the case.
We know from research that even with a rape exception, most rape victims who seek an abortion will be denied. Take Medicaid, for instance, which will not cover an abortion unless the patient is a rape victim. Research by Ibis Reproductive Health, a nonprofit organization dedicated to improving women’s access to reproductive services, has shown that only 37 percent of women who qualified for rape exceptions got the necessary funding for their abortions. Between the onerous paperwork demands to demonstrate that one is, to use Akin’s term, a “legitimate” rape victim and bureaucrats who are understandably anxious about making exceptions even when they’re called for, doctors and patients simply found it impossible to get the funding they need.
In this light, what’s surprising is not that an anti-choice politician accused pregnant rape victims of lying to cover their shame, but that anti-choice politicians manage to avoid saying similar things with regularity. Unfortunately, we live in a political climate where statements like Akin’s will likely be dismissed as a gaffe instead of serving as an opportunity to discuss what motivates such myths. Such is the nature of our shallow, scandal-driven media: It points our heads in the direction of deeper truths, but moves to the next story before we can take the time to see them.
By: Amanda Marcotte, The American Prospect, August 20, 2012
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