Ryan Plan “V” Word: A Voucher By Any Other Name…
When President Obama met with congressional Republicans this week, GOP leaders were particularly incensed about Democrats using the word “voucher” when describing the Republican plan to end Medicare. Paul Ryan and others prefer “premium support,” and consider the Dems’ rhetoric to be “demagoguery.”
There are two main problems with this rhetorical disagreement. The first is that the GOP plan really does rely on vouchers, whether the party cares for the word or not. The second is that plenty of far-right Republicans are inclined to ignore their party’s talking-point instructions.
Here, for example, was Sen. Ron Johnson (R) of Wisconsin, a Tea Party favorite, explaining one of the things he likes most about his party’s Medicare plan.
“What I like about the Paul Ryan plan is it’s trying to bring a little bit of free-market principles back into Medicare.
“If you need subsidized care, we’ll give you vouchers. You figure out how you want to spend. You select what insurance carrier you want to use. It’s a start.”
It’s not just Johnson. Last week, GOP presidential hopeful Herman Cain argued, “Nobody’s talking about the fact that the centerpiece of Ryan’s plan is a voucher. Now, a lot of people don’t like to use that term because it has a negative connotation. That is what we need.” Even Fox News has referred to the Republican plan as being built around “vouchers.
If conservative Republicans are using the word, why is it outrageous when Democrats do the same thing? Are Johnson, Cain, and the Republican cable news network all secretly siding with the left?
As for the substance behind the claim, it’s worth noting that this isn’t just about semantics — the GOP claim that their scheme doesn’t include vouchers is just wrong. Paul Krugman explained yesterday:
[T]he ACA is specifically designed to ensure that insurance is affordable, whereas Ryancare just hands out vouchers and washes its hands. Specifically, the ACA subsidy system (pdf) sets a maximum percentage of income that families are expected to pay for insurance, on a sliding scale that rises with income. To the extent that the actual cost of a minimum acceptable policy exceeds that percentage of income, subsidies make up the difference.
Ryancare, by contrast, provides a fixed sum — end of story. And because this fixed sum would not grow with rising health care costs, it’s almost guaranteed to fall far short of the actual cost of insurance.
This is also why Ryancare is NOT premium support; it’s a voucher system. No matter how much they say it isn’t, that’s exactly what it is.
Given this reality, why do Republicans throw such a fit about the use of the “v” word? Because vouchers don’t poll well. For the right, the key is to come up with phrasing, no matter how deceptive, that persuades the public. If GOP leaders throw a big enough tantrum, they’re hoping everyone — Dems, pundits, reporters, even other Republicans — will use the words they like, rather than more accurate words that make the party look bad.
No one should be fooled.
By: Steve Benen, Contributing Writer, Washington Monthly Political Animal, June 4, 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
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