The Romney-Ryan Plan to Gut Medicaid

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Common Dreams

The Romney-Ryan Plan to Gut Medicaid

There are few better ways to really stick it to the poor than cutting off their access to health care, but that's exactly what the Romney-Ryan ticket's proposed cuts to Medicaid would do.
 
Lumped in with other enormous structural changes to the American safety net like privatizing Medicare, Paul Ryan's proposed changes to the Medicaid system haven't gotten the attention they deserve. Former President Bill Clinton devoted a portion of his prime-time speech at the Democratic National Convention broadly explaining Ryan's proposal, which Romney has embraced, but unlike the attention on Medicare and Social Security Democrats have so far not effectively pounced on this policy point. They should.
 
Medicaid provides free or low cost health coverage to more than 50 million children, families, pregnant women and people with disabilities. Medicaid is run as a partnership with the federal government with the federal government establishing the overall rules for what kinds of services are covered. The federal government also provides a lot of the funding for Medicaid. But Medicaid is administered separately by each state and, generally speaking, states are granted a lot of leeway in the administration of Medicaid dollars.
 
Because the health care industry cannot adequately manage the costs of delivering health care, and because of decades of stagnant wage growth followed by a deep recession, Medicaid costs have soared. It's a crisis spiral where the program is increasingly costly to run because more Americans than ever are in need of its services.
 
Romeny-Ryan's proposed solution to the ballooning costs of care under Medicaid is to cut funding so indiscriminately and so drastically that the program dies altogether. Here is his plan. First, cut 34% of the Medicaid budget. Just cut it. Make a program that has expanding enrollment because more Americans are poor and in need too broke to run.
 
The story behind this part of Romney-Ryan is the Republicans’ pathological opposition to Obamacare. Under health care reform Medicaid income eligibility is lowered so more people can have access to care. It's a key portion of the reform – reaching out to the working poor who are not so poor they currently qualify for Medicaid but who work low-wage jobs without benefits and can’t afford insurance on their own. If they can’t directly repeal the legislation, the Republicans propose to cut off its financial air supply.
 
The second prong of Romney-Ryan would eliminate nearly all federal rules on what services states must cover under Medicaid. We know what this part of the plan looks like because it's currently playing out in Texas, where former presidential candidate and current Republican governor Rick Perry's administration took away health care access from nearly 160,000 women, children and families by shutting down the Women's Health Program as part of Perry's crusade to defund Planned Parenthood.
 
The Romney-Ryan plan is disastrous for Americans. The nonprofit Kaiser Family Foundation estimates the plan would knock more than 30 million people off the Medicaid rolls. The plan would also financially crush many of the nation's hospitals, especially those that serve inner cities. For those hospitals Medicaid is a the financial lifeline that allows them to stay in business and provide health care to the patients that walk in their doors. Without Medicaid many of those patients would have no way to pay. Hospitals would close and cities would become health care deserts with no care readily available even for those who could afford it.
 
And let’s be clear about the kinds of services Medicaid provides. Vaccinations. Prenatal and postnatal care. Well visits, cancer screens and family planning services. How exactly does a nation take away vaccinations and preventive care to more than 30 million people without provoking a public health crisis?
 
In its drive to redistribute wealth to the rich, and strip millions of basic necessities, the Republican party seems bent on turning this country into a third-world oligarchy.  There’s a word for such a program:  un-American.

Bruce Hay

Bruce Hay is a Professor at Harvard Law School.

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