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Clinton Paints GOP Threat to Medicaid by the Numbers

September 6, 2012

Bill Clinton's address to the Democratic National Convention accomplished a good many things for his party. Among them was shining a spotlight on one of the least reported but potentially most far-reaching proposals Mitt Romney and his Republican Party have promised to pursue. While all eyes have been on the Romney-Ryan plan to voucherize Medicare, the Republican promise to slash Medicaid spending by a third over the next decade has largely gone unnoticed. But it shouldn't. The result would not only be the loss of health insurance for millions of lower-income Americans in the coming years, but devastating cuts to nursing home care for seniors and coverage for the disabled starting in 2013.
Mitt Romney along with the 98 percent of Congressional Republicans who voted for the Ryan House GOP budget don't merely support the repeal of the Affordable Care Act and with it prevent over 30 million people from obtaining health insurance. As ThinkProgress explained, their cuts to Medicaid "start immediately and cut the program 35 percent by 2022 -- a loss of $810 billion over that time period." Last night, President Clinton did the arithmetic for the American people:

They also want to block grant Medicaid and cut it by an third over the coming ten years. Of course that's gonna really hurt a lot of poor kids. But that's not all. 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... 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 syndrome or autism or other severe conditions.

And with that, David Frum acknowledged, "Clinton Socks GOP in its Glass Jaw." On stage Wednesday night, Frum fretted for his conservative allies, "former president Clinton detonated the H-bomb of the 2012 campaign":

Republicans have promised to hold harmless from Medicare changes everyone under age 55, assuring high-voting senior citizens that they have nothing to fear from Republican budget plans. But while Medicare is left alone until 2023, Medicaid is immediately subject to very large cuts. Many of us may think of Medicaid as above all a program for the poor. It is also, however, increasingly the way in which America pays for nursing home care -- and indeed nursing care is the fastest-growing part of Medicaid.

(Frum is actually wrong about Medicare being "left alone until 2023. By repealing the Affordable Care Act, Mitt Romney would roll back benefits already in place including the end of the prescription drug "donut hole" and free preventive care.)
But the Big Dog's revelations are even bigger trouble for Republicans. In a nutshell, health care is worst where the GOP polls best. And it will be red states who will suffer most if President Romney succeeds in killing Obamacare and gutting Medicaid.
Currently, the $350 billion Medicaid program serves roughly 63 million Americans. On average, the federal government picks up 57% of the tab, with poorer states like Mississippi and Alabama getting 75% of the funding from Washington. Medicaid not only pays for a third of nursing home care in the United States; it covers a third of all childbirths. (In Texas, the figure is one-half.) As with Medicare, Medicaid provides insurance for substantially less than private insurers (27% less for children, 20% for adults), while new studies from Oregon and Massachusetts show it dramatically improves the health of its recipients. (So much for the claims of Republicans like Tennessee Senator Lamar Alexander, who charged that Medicaid is "a medical ghetto" that "none of us, or any of our families, would ever want to be a part of for our health care.")

But the worry for red state residents isn't just that South Carolina's Nikki Haley, Florida's Rick Scott and many of the same GOP governors who brought the suit against the Affordable Care Act have said they will reject the new dollars from Washington that could help cover 27 million uninsured in their states. With the no-strings attached block grants from a Romney administration, they would assuredly cut their dismal state programs further. As Jonathan Cohn explained:

That's not to say plenty of governors wouldn't take advantage of block grant status to change their Medicaid programs in ways they cannot now. They surely would--by capping enrollment, thinning benefits, increasing co-payments, and so on.

To understand how the Medicaid would work in the Romney-Ryan future, just look at Mississippi's present. New York's former Medicaid director Deborah Bachrach warned, "If Mississippi opted out of the 2014 expansion of Medicaid, poor childless adults wouldn't gain coverage in that state; at the same time, the state could roll back eligibility for parents with children who are currently enrolled, reducing the number of participants in the program." But as Glenn Kessler explained in the Washington Post last year, it is hard to believe that a state like Mississippi could make it current program any worse:

Mississippi provides some of the lowest Medicaid benefits to working adults in the nation. A parent who isn't working can qualify only if annual family income is less than 24 percent of the poverty line. Working parents qualify only if they make no more than 44 percent of the federal poverty level. Seniors and people with disabilities are eligible with income at 80 percent of the poverty line...
Translated from the federal poverty guidelines, that means a working Mississippi couple with one child could earn no more than $8,150 a year and still qualify for Medicaid, seniors and people with disabilities could earn no more than $8,700, and a pregnant woman could earn no more than $20,000 a year.

None of what Bill Clinton highlighted in Charlotte is anything new. After all, Bloomberg News, the Washington Post and McClatchy have been reporting for months that the Romney-Ryan proposals would hurt the poor, the elderly and the disabled. But sometimes, you need a Big Dog to teach Americans about the Republicans' new tricks.


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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