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GOP idea would devastate Medicaid

The plan to be unveiled by U.S. Rep. Paul Ryan will propose making Medicaid a block grant, ending assurances that the poor will have coverage.

U.S. Rep. Paul Ryan

U.S. Rep. Paul Ryan U.S. House of Representatives

The national budget debate is multi-directional. Most of the story, so far, has centered on this year’s federal spending, basically how to strip dollars from a fiscal year that’s roughly half over. Then there is the fight over next year’s budget, the one that is supposed to start on Oct. 1. And, at the same time, there is an argument about the role of the federal government and long-term spending promises.

I think of these issues a bit like a line from the movie, Ghostbusters. “Don’t cross the streams,” one of the characters warns. “Why?” asks another.

“It would be bad.”

We’re at the point in our story where the streams are crossing. The flash of lights and heated rhetoric make it difficult, if not impossible, to explore the issues with either a methodical or strategic approach. We’re a captive to the budget as a show, played on so many stages.

But underlying the theatrics is a basic truth, that much of the growth of government spending stems from demographics, not out-of-control government agencies. Simply put: We have a large older population asking a smaller younger cohort to pay the bills. The cost of an aging society is not just a problem in the United States; it’s a global trend.

This is why health care reform matters: We have to lower the cost of health care if we want any chance at a real solution.

This week House Budget Chairman Paul Ryan, R-Wisconsin, will propose sweeping changes to Medicare and Medicaid. “Starting 10 years from now, in 2021, Americans would no longer enroll in the Medicare program, but instead receive vouchers for private insurance,” says a report on CNN. “On Medicaid, Ryan’s plan calls for deep cuts, as much as $1 trillion. The program would also fundamentally change — the federal share of the Medicaid system would become block grants to the states.”

The Medicaid portion of this plan has huge implications for Indian Country. The Indian Health System has been improving its systems for collecting money from third-party sources, including Medicaid. Medicaid is a partnership with the federal and state governments (the federal government pays a range from about half to three-quarters of the cost) and states in recent years have complained about their share that arrangement.

Ryan’s proposal would give states money with few restrictions and let them design the system that works best for them.

The problem is that Medicaid is supposed to several things at once. One focus — the one that gets most of the attention — is a government health insurance program for the poor. Some 60 million children and adults are now covered and the expansion of Medicaid by at least another 16 million people is a key component of the Patient Protection and Affordable Care Act. (Medicaid already represents 16 percent of all health care spending.)

But another charge of Medicaid is paying for long-term care, primarily for the elderly. Roughly 40 percent of all long-term care spending is Medicaid.

That difference in mission is critical to the political support of Medicaid. State legislators might be eager to cut services, eligibility, and other programs for the poor. But not quite so zealous when it comes to paying the cost of nursing homes and other long-term care facilities.

The big deal here is that now anyone eligible for Medicaid, young or poor, is supposed to be served. If the program shifts to block grants, that guarantee will disappear. The federal money will be capped — and states will likely do the same. And in theory, state and federal budgets will be balanced.

There is no way that politicians would kick elderly out of nursing homes to save money, so most of the block grant cuts would be at the expensive of children and poor people. Only people still get sick — and without basic Medicaid coverage they will show up in another part of the system, such as emergency rooms, and health care costs will continue to explode.


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Comments:

Posted Mon, Apr 4, 12:43 p.m. Inappropriate

The Twitter Poet belongs on the opinion page.

BlueLight

Posted Mon, Apr 4, 1:58 p.m. Inappropriate

But if Paul Ryan gets his way how will the teabaggers get their electric scooters?

andy

Posted Mon, Apr 4, 4:42 p.m. Inappropriate

First, this appears to be an opinion piece. Why is it in the news section?

Secondly, Mr Trahant does a nice job of replaying the same old argument of sympathetic people who will lose benefits when those benefits are cut. But he fails to confront the very real problem: we are completely out of money. The federal government runs a $1.6 trillion dollar annual deficit - that's $4 billion dollars every day. The state is not in much better shape.

What is Mr Trahant's answer? Stick our head in the sand? Pretend there is no problem? If it's to tax the rich ... there are many articles explaining that even if we confiscate the wealth of the top earners, we can't pay for it all.

Then Mr Trahant ignores the moral argument - what right do the people he is writing about have to stick their hand out and say more, more more? I don't care if you are broke, keep giving me more? How come we never feel thanks for the generosity of those who pay for the befits who go to those who don't? All we hear from the people receiving these payouts is it is never enough, and you can never stop or reduce what we are giving people.

Slaggggg

Posted Mon, Apr 4, 5:40 p.m. Inappropriate

I would like to hear more about this assertion / conclusion:

universal health care coverage (is) the only sure way to lower the overall cost of health care.

Is it? Some would say the way to lower the cost of health care is to invest in public health. This does not necessarily follow from having universal health care. Others would say the way to lower the cost of health care is to have people do their own shopping and have co-pays for at least some items that make them more price-sensitive. Co-pays are not necessarily a part of universal health care coverage either. To many, universal health care coverage means no co-pays, just consume as much as you want.

sjenner

Posted Mon, Apr 4, 7:53 p.m. Inappropriate

Ray Scheppach, the recently retired head of the National Governors Association, formed a bipartisan coalition of governors in opposition the last time this half-baked block grant idea came up in Congress. Back then, Scheppach understood clearly everything that you discussed: that the block grant program would jeopardize coverage for the low income. It gives Congress much greater freedom to set the funding level, so look for Medicaid to be an expendable budget item in Congress as well as in legislatures. Another flaw with the block grant scheme is that it is likely to create inequity; those states with the greatest need will be short-changed (the most).

On the Republican side, nothing has changed. Paul Ryan is cynically using an exaggerated fiscal crisis to trot out a stale, middle-finger idea from the Gingrich era. The real question is whether there will be the leadership this time to stand up to it.

Posted Mon, Apr 4, 7:55 p.m. Inappropriate

Mr. Trahant is to be congratulated for pointing out the devastating impact of the radical right's proposed budget cuts on middle and lower income people.

It's clear that not only is it a heartless form of politics, but that it also serves the interests of the radical right's masters, the billionaires who fund the right wing think tanks and political campaigns.

Currently, they have over-powered the dialogue regarding what type of society the United States should be. One of community sharing of resources and responsibilities? Or one where the desires of the masters of capital hold sway and everyone else is smacked down to their knees?

Contrary to the highly erroneous opinion of Slaggg, the United States is not at all broke. It is still fabulously rich with the wealth more and more concentrated in the hands of fewer people who less and less give a damn about the well-being of the nation since in a globalized world their wealth comes from all corners of the planet.

More and more, I wonder why middle and lower class people should even bother paying taxes since our governments--federal and state--increasingly provide them with less benefits. Less education, less health care, poorer roads etc.

It seems like we are now entering a whole new era where middle and lower income people are increasingly being asked to subsidize the rich as a result of the regressive forms of taxation that are becoming the norm.

Posted Tue, Apr 5, 8:40 a.m. Inappropriate

No proofreader Crosscut? More than that though, I'm curious about the author's utter lack of substance beyond whining. Where is his solution? Attack before anything is even presented? Does he not realize that a former Clinton staffer helped shape this plan? Better try to kill it early before anyone actually gets a chance to debate it on the merits. See this piece from Forbes for some perspective:

http://blogs.forbes.com/aroy/2011/04/04/the-pre-emptive-progressive-attack-on-entitlement-reform/?partner=daily_newsletter

Posted Tue, Apr 5, 9:11 a.m. Inappropriate

Pepper2000: Please substantiate your claim that the financial crisis is "exaggerated". The government borrows 40% of each dollar it spends. What family or business could go on like that for years? Greece provides a very real example of the coming reckoning. What has been exaggerated?

Anotherview: See the revenue vs spending chart here: http://reason.com/archives/2011/04/01/the-truth-about-deficits-and-t.
How can you just say we have plenty of wealth? The problem is spending, not revenue.

Slaggggg

Posted Tue, Apr 5, 9:25 a.m. Inappropriate

Why does universal health care lower the costs? Fewer forms, no middle men between doctors who prescribe a cure and patients who get it. What benefit does the patient or the doctor get by having an insurance adjuster review the claim? None! As long as insurance is run as a for profit industry, we'll have increased the costs unnecessarily.

Why does having government involved in the payment of health care costs make sense? First, it gives it an incentive to regulate things which are injurious to people, ie unnecessary and possibly poisonous food coloring would be banned. Second every one needs health care at some point in their lives. It's not a matter of what you do for a living, house cleaning, postal worker, high tech worker. You're going to need care.

Risks associated with that job can increase injury rates through poor training and poor regulation. ie. Massey Mining kills it's workers through poor working conditions. Thus if taxpayers are footing the bill directly there is an incentive to have Massey Mining fix their dang mines to be safer.

Thirdly governments cut things like Gym class to save money in schools. But it turns out that exercise promotes better health in children. Having a stake in both outcomes means that cutting one program which increases the cost in another is an incentive to not cut Gym. Especially when the cost savings by promoting exercise are huge in the health care business.

Fourthly government spends tons of money promoting automobiles which kill people directly because they hit each other, pedestrians, bicyclists etc. By funding more mass transit so that people don't need to drive everywhere, has savings in health care costs.

Once government has some skin in the health care debate many positive things fall out.

What Republthugs don't want people to have is evidence that working together via government can improve peoples lives because it makes a mockery of the small government no regulation propaganda they put out.

GaryP

Posted Tue, Apr 5, 9:45 a.m. Inappropriate

To the silly little brats that speak of sick people "taking all they want."

It's not about taking what they want. It's about people who are sick getting what they need in a society where an ever fewer have ever more.

If you simply don't care about others, that's a perfectly defenseable position, but say so. Don't cry about greedy sick people.

Goforride

Posted Tue, Apr 5, 10 a.m. Inappropriate

Goforride: No one is talking about cutting health care for the elderly. Rather, the debate is about what limits should be put on that care? The current path of a no-limits approach to health care for all is simply not sustainable.

Would it be OK to put limits on what care the government will pay for? If so - that's the debate being had here. Mr Ryan has one proposal for what those limits should be. Neither Mr Trahant nor yourself has offered any alternative.

Do you deserve unlimited handouts from the government?

Slaggggg

Posted Tue, Apr 5, 12:03 p.m. Inappropriate

Picture this: you have a long skinny sealed balloon with air in it. You grab it and squeeze. Did the air where you squeeze go away? It may feel like it to your hand but your eyes and brain tell you that all you did was put additional pressure elsewhere in the balloon.

One item that is omitted from this piece is that even today, with Medicare coverage, the care providers/insurers who deal with Medicare and Basic Health programs lose money at it. Since that money has to come from somewhere, it comes from those of us who can afford it (e.g. higher premiums to cover these losses). The current system is one of spiraling costs and the proposed block grants will only compound the problem (although it might make some short-term-politicians feel like the problem is lessened).

IMHO

Posted Tue, Apr 5, 12:10 p.m. Inappropriate

Lets talk about "vouchers". You know what they are, a coupon for a service. If there was any way you could know the price of medical care it might make sense to have a coupon for X% off the total price. or $Y dollars toward a service.

But: No layman knows what the cost of medical care should be. How much should I give an orthopedic doctor to set my broken leg? Do poor people get interns and rich people full doctors? That's what happens now if you show up at a teaching hospital like Harborview or the UW. The trainees train on the poor. (under supervision of course....)

And how to we rate who gets enough money to do a particular procedure? Do hedgefund managers who make a ton of money get coupons for anything because their "value" to society is such that we should subsidize them? And garbage men, who we can get a dime a dozen don't? What is the value of a person's life? Is it their earning potential? Or the potential of their children? We have no idea where the next geniuses are going to be born, but we do our best to keep poor kids poor and limit their chances. When we do this we lose out.

Remember it's a game of numbers, more kids will be born in India who rank in the to 10% of IQ than will be born at all in the USA. Do we really want to let the poor but genius kids languish from lack of health care?

Does everybody deserve unlimited care? No, the terminally ill will die, maybe we shouldn't spend millions trying to keep them alive and not spend the money on preventive medicine for everybody. So perhaps we should enact the death panels and let them pick who lives and who dies. We have them already but operating as insurance adjusters.

But as a taxpaying investor in the people of this country (I help pay to put kids through school etc.) I think it's short sighted to cut the heath care of these people via block grants and vouchers. Especially when it seems like we have infinite money to spend on foreign wars.

GaryP

Posted Tue, Apr 5, 9:57 p.m. Inappropriate

Since I was asked to do so, I will clarify what I meant by "exaggerated" financial crisis. The United States is not Greece. There is not a national bankruptcy nor will there be one in the foreseeable future. I don't wish to present a pollyannish view of the situation, but neither is the falling-sky viewpoint, so enthusiastically promoted by Paul Ryan and others, a responsible way to conduct policy. A reasonable combination of tax increases (primarily on the highest income earners), overhaul of the system of exemptions, spending cuts--especially in the area of defense and unneeded weapons systems--and fair adjustments to entitlement programs is the best way to deal with current fiscal challenges.

Posted Wed, Apr 6, 9:55 a.m. Inappropriate

devestate Medicaid? thats hysterical. over 50% of doctors already flatly refuse to treat Medicaid cases its such a joke. Death panels? Oh, you mean paliative care. Why is it that so many people with college educations and decent IQ's approach this subject without an ounce of real information or hands on knowledge of the issues. All I can say is that the posters here obviously haven't personally come into contact with the Medicaid based healthcare system yet.

beaky

Posted Wed, Apr 6, 9:57 a.m. Inappropriate

my definition of a fool: anyone who has bought into the "us vs them" schemes cooked up by the political industrial complex to devert attention to the coming meltdown. if you think there is a gram of difference between the GOP and the Demos aside from the salespitch, you are an idiot.

beaky

Posted Wed, Apr 6, 12:01 p.m. Inappropriate

beaky there is a difference, but both parties have their foot firmly on the gas pedal and neither seems willing to get us out of the mess. However there's bad and then there's worse.

GaryP

Posted Thu, Apr 7, 11:23 p.m. Inappropriate

Medicaid also covers people with disabilities who don't qualify for Medicare. Cutting off the poor and the old won't get rid of those people. However, if you do away with Medicaid entirely, they will all eventually die, because there won't be enough hospital emergency rooms left to treat them all.

SJenner and all those who consider health care a "consumer" product, show me how you can prevent getting leukemia by being a smart shopper of medical care. Show me how you can get a good insurance policy by going out into the marketplace with a voucher and taking bids from insurance companies like you would from car dealers. Show me how you can find affordable medications by choosing the right pharmacy. Show me how you will pay for doctor visits and lab tests that can cost $150 on up when you have been "smart" enough to buy only a catastrophic insurance policy because you didn't plan on getting sick. Show me how you get medical help for your sick child when that child is too young to know how to be a good shopper, and you thought you knew it all.

sarah90

Posted Mon, Apr 18, 7:37 a.m. Inappropriate

Slaggggg-

Goforride: No one is talking about cutting health care for the elderly. Rather, the debate is about what limits should be put on that care? The current path of a no-limits approach to health care for all is simply not sustainable.

Would it be OK to put limits on what care the government will pay for? If so - that's the debate being had here. Mr Ryan has one proposal for what those limits should be. Neither Mr Trahant nor yourself has offered any alternative.

Do you deserve unlimited handouts from the government?

— Slaggggg"

Neither I, nor anyone deserves a handout from anyone. Of course, that isn't what were talking about here.

First, the "government" isn't some entity as if it were Uncle Sam. The government is simply the mechanism through which we collectively address collective needs.

Second, no one is ever talking about anything unlimited. What we are talking about is meeting the legitimate medical needs, as defined by the best available science, to members of our community who need it. It is all about collective responsibility for collective security. We all pay with the knowledge that if, at anytime in our lives we need help, we'll get it.

It's not like we can't afford it in a country where we had the Chinese finance a trip down a half-a-trillion dollar rathole in Iraq.

Goforride

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