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“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

September 6, 2012 Posted by | Election 2012 | , , , , , , , , | Leave a comment

“Truth And Lies About Medicare”: Voters Can’t Believe Anything Republicans Say

Republican attacks on President Obama’s plans for Medicare are growing more heated and inaccurate by the day. Both Mitt Romney and Paul Ryan made statements last week implying that the Affordable Care Act would eviscerate Medicare when in fact the law should shore up the program’s finances.

Both men have also twisted themselves into knots to distance themselves from previous positions, so that voters can no longer believe anything they say. Last week, both insisted that they would save Medicare by pumping a huge amount of money into the program, a bizarre turnaround for supposed fiscal conservatives out to rein in federal spending.

The likelihood that they would stand by that irresponsible pledge after the election is close to zero. And the likelihood that they would be better able than Democrats to preserve Medicare for the future (through a risky voucher system that may not work well for many beneficiaries) is not much better. THE ALLEGED “RAID ON MEDICARE” A Republican attack ad says that the reform law has “cut” $716 billion from Medicare, with the money used to expand coverage to low-
income people who are currently uninsured. “So now the money you paid for your guaranteed health care is going to a massive new government program that’s not for you,” the ad warns.

What the Republicans fail to say is that the budget resolutions crafted by Paul Ryan and approved by the Republican-controlled House retained virtually the same cut in Medicare.

In reality, the $716 billion is not a “cut” in benefits but rather the savings in costs that the Congressional Budget Office projects over the next decade from wholly reasonable provisions in the reform law.

One big chunk of money will be saved by reducing unjustifiably high subsidies to private Medicare Advantage plans that enroll many beneficiaries at a higher average cost than traditional Medicare. Another will come from reducing the annual increases in federal reimbursements to health care providers — like hospitals, nursing homes and home health agencies — to force the notoriously inefficient system to find ways to improve productivity.

And a further chunk will come from fees or taxes imposed on drug makers, device makers and insurers — fees that they can surely afford since expanded coverage for the uninsured will increase their markets and their revenues.

NO HARM TO SENIORS The Republicans imply that the $716 billion in cuts will harm older Americans, but almost none of the savings come from reducing the benefits available for people already on Medicare. But if Mr. Romney and Mr. Ryan were able to repeal the reform law, as they have pledged to do, that would drive up costs for many seniors — namely those with high prescription drug costs, who are already receiving subsidies under the reform law, and those who are receiving preventive services, like colonoscopies, mammograms and immunizations, with no cost sharing.

Mr. Romney argued on Friday that the $716 billion in cuts will harm beneficiaries because those who get discounts or extra benefits in the heavily subsidized Medicare Advantage plans will lose them and because reduced payments to hospitals and other providers could cause some providers to stop accepting Medicare patients.

If he thinks that will be a major problem, Mr. Romney should leave the reform law in place: it has many provisions designed to make the delivery of health care more efficient and cheaper, so that hospitals and others will be better able to survive on smaller payments.

NO BANKRUPTCY LOOMING The Republicans also argue that the reform law will weaken Medicare and that by preventing the cuts and ultimately turning to vouchers they will enhance the program’s solvency. But Medicare is not in danger of going “bankrupt”; the issue is whether the trust fund that pays hospital bills will run out of money in 2024, as now projected, and require the program to live on the annual payroll tax revenues it receives.

The Affordable Care Act helped push back the insolvency date by eight years, so repealing the act would actually bring the trust fund closer to insolvency, perhaps in 2016.

DEFICIT REDUCTION Mr. Romney and Mr. Ryan said last week that they would restore the entire $716 billion in cuts by repealing the law. The Congressional Budget Office concluded that repealing the law would raise the deficit by $109 billion over 10 years.

The Republicans gave no clue about how they would pay for restoring the Medicare cuts without increasing the deficit. It is hard to believe that, if faced with the necessity of fashioning a realistic budget, keeping Medicare spending high would be a top priority with a Romney-Ryan administration that also wants to spend very large sums on the military and on tax cuts for wealthy Americans.

Regardless of who wins the election, Medicare spending has to be reined in lest it squeeze out other priorities, like education. It is utterly irresponsible for the Republicans to promise not to trim Medicare spending in their desperate bid for votes.

THE DANGER IN MEDICARE VOUCHERS The reform law would help working-age people on modest incomes buy private policies with government subsidies on new insurance exchanges, starting in 2014. Federal oversight will ensure a reasonably comprehensive benefit package, and competition among the insurers could help keep costs down.

But it is one thing to provide these “premium support” subsidies for uninsured people who cannot get affordable coverage in the costly, dysfunctional markets that serve individuals and their families. It is quite another thing to use a similar strategy for older Americans who have generous coverage through Medicare and who might well end up worse off if their vouchers failed to keep pace with the cost of decent coverage.

Mr. Romney and Mr. Ryan would allow beneficiaries to use vouchers to buy a version of traditional Medicare instead of a private plan, but it seems likely that the Medicare plan would attract the sickest patients, driving up Medicare premiums so that they would be unaffordable for many who wanted traditional coverage. Before disrupting the current Medicare program, it would be wise to see how well premium support worked in the new exchanges.

THE CHOICE This will be an election about big problems, and it will provide a clear choice between contrasting approaches to solve them. In the Medicare arena, the choice is between a Democratic approach that wants to retain Medicare as a guaranteed set of benefits with the government paying its share of the costs even if costs rise, and a Republican approach that wants to limit the government’s spending to a defined level, relying on untested market forces to drive down insurance costs.

The reform law is starting pilot programs to test ways to reduce Medicare costs without cutting benefits. Many health care experts have identified additional ways to shave hundreds of billions of dollars from projected spending over the next decade without harming beneficiaries.

It is much less likely that the Republicans, who have long wanted to privatize Medicare, can achieve these goals.

 

By: Editorial, The New York Times, August 18, 2012

August 20, 2012 Posted by | Election 2012 | , , , , , , , , | Leave a comment

   

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