Tomorrow House Republicans will unveil their plan for reducing the federal deficit. It’s the brainchild of the GOP policy wunderkind Paul Ryan, who hails from my home state of Wisconsin. If this is the best wonk, the nation is well and truly fucked. I use that epithet because that’s exactly what this plan would do to the elderly, poor, and people with disabilities. It savages Medicare and Medicaid by cutting trillions of dollars from both programs while making the Orwellian claim that these cuts will promote “reform.” I’ll look at the Medicare cuts tomorrow, but let’s take a look at how Medicaid would fare.
Right now, Medicaid is an “entitlement” program, which means that anyone who is eligible for the program is entitled to its benefits. Medicaid rolls increased exponentially during the recession because more people became eligible as they lost their jobs and their income. Ryan’s plan would transform Medicaid into a block grant, which means that states would get a fixed amount of money to spend on their Medicaid programs. Once the yearly allotment is used up, that’s it. What happens if another recession hits and the allotment isn’t sufficient to provide services to everyone who is eligible? Too bad.
But it gets even better. States would have wide latitude to set eligibility criteria and determine what services to offer. Since states have to stay within their allotted grant caps, they will have every incentive to restrict eligibility as much as possible. Many working poor families who rely on Medicaid because they can’t afford private insurance might find themselves without health coverage because their incomes would be too high under “reformed” Medicaid. Medicaid buy-in programs like the one I use to purchase Medicaid so that I can keep working could disappear because “reformed” Medicaid can’t afford to support employed people with disabilities. On the services side, the same dynamic exists. States may decide to cut services to the bare essentials, leaving many people without access to therapies and treatments that keep them out of the emergency room. Nursing homes would probably survive because they are a politically powerful lobby (nobody wants to imagine Grandma out on the street), but at the cost of home and community-based services that keep people with disabilities and the elderly out of such facilities. Much of the progress made over the last few decades in integrating people with disabilities into the community would be lost.
Medicaid serves an inherently vulnerable and politically disenfranchised population: the poor, people with disabilities, and the elderly. “Reformed” Medicaid would make this population only more vulnerable to the whims of legislators who might not be terribly sympathetic to their plight. Of course, that’s exactly what Ryan and his colleagues intend.
Tomorrow, we’ll look at the proposed cuts to Medicare.
