Political Animal


August 13, 2012 4:54 PM Another Reminder: Medicaid, Not Medicare, Biggest Target For Conservatives

By Ed Kilgore

At the risk of sounding like a broken record on this subject, I devoutly hope that in their rush to tie Mitt Romney to Paul Ryan’s Medicare proposal, progressives don’t forget that there has never been much space between the two running-mates on the national health care program Ryan’s budget would really destroy: Medicaid. Wonkblog’s Suzy Khimm has a reminder today:

Paul Ryan’s Medicare overhaul may be the most controversial part of his budget.But the proposed cuts to the program are not the biggest cuts in the plan.
As Ezra notes, Ryan’s cuts to Medicare “are only 60 percent as large as the cuts to Medicaid and other health-care programs.” What’s more, his biggest change to Medicare wouldn’t kick in until 2023—the start date for his voucher-based premium support program. By comparison, Ryan’s cuts to Medicaid are more drastic, and they start sooner: Between 2013 and 2022, it would make nearly $1.4 trillion in cuts to Medicaid that “would almost inevitably result in dramatic reductions in coverage” as well as enrollment, according to the non-partisan Kaiser Family Foundation.
Over the next 10 years, the Ryan plan would cut Medicaid by $642 billion by repealing the Affordable Care Act and by $750 billion through new caps on federal spending—a 34 percent cut to Medicaid spending over the next decade, according to Edwin Park of the Center and Budget and Policy Priorities.
Who would that impact? First, by overturning the ACA, the Ryan plan would prevent 11 million people from gaining Medicaid coverage by 2022, according to the Congressional Budget Office’s latest estimates….
If states maintained their current level of spending for each Medicaid patient, 19 million more people would have to be cut from the program in 2021 because of Ryan’s block-grant reform, according to the Kaiser Family Foundation. If states managed to curb health-care spending growth in Medicaid, 14 million beneficiaries would still lose Medicaid coverage under the Ryan plan. And that’s on top of the 11 million Americans who would lose Medicaid coverage because the Ryan plan would repeal Obamacare. So all in all, Ryan’s cuts could mean as many as 30 million Medicaid beneficiaries lose their coverage.

Yeah, yeah, I know, old folks vote and in the last two cycles a majority have voted Republican, and po’ folks don’t vote so much, and far more already vote Democratic. But Lord a-mighty: 30 million people potentially losing their health insurance because Romney and Ryan think they need to show more moral fiber. Given Romney’s support for the entire Ryan Budget, that doesn’t even get into the damage wreaked on efforts to help the poor escape from total dependence on cash assistance or private charity by the combined cuts to Medicaid, food stamps, and the earned income tax credit that budget contemplates. And on top of all that, many millions of indigent seniors depend on Medicaid for nursing home care.

So before progressives decide to devote all their time to endless arguments over exactly which term to use for what the Ryan Budget proposes to do to Medicare—vouchers, cost-shifts, abandonment, abolition-of-Medicare-as-we-know it—don’t forget about Medicaid. That’s the Great Society safety net program with the biggest bullseye painted on it.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • Anonymous on August 13, 2012 5:14 PM:

    The ad writes itself:
    Ad target: seniors and their adult children

    Senior: but I like living here with my friends, and the activities. And I feel badly for my children that I have to inconvenience them. And neither of them are healthcare professionals. I'm going to need so much help; how is that going to work?

    Children: are sitting around the kitchen table - I can't believe mom/dad has to move in with us because her/his Medicaid was cut. Do we have room? How are we going to care for her/him - all those medications - they're so expensive. We'll have to retrofit our bathroom with handicapped equipment. One of us is going to have to quit our job so we can take care of mom/dad.

    So freaking easy.

    Not easy: Captcha today. I'm already on the 10th refresh and haven't been able to read any of them! Please fix!!!

  • Anonymous on August 13, 2012 5:20 PM:

    Oops, tag line for the ad:
    This is what Romney and Ryan have in mind for America, cutting healthcare for our most vulnerable citizens. Costing us all. Is this the America we envision?

    Of course you could also make sob story ads with sick poor children, grandma living on the street, Ryan pushing grandma off a cliff - oh wait.

    Do those sad ASPCA cat/dog ads raise money?

    Captcha: averyPub acquiesced,? Really?

  • Marvin on August 13, 2012 5:41 PM:

    Seven out of ten nursing home patients are on Medicaid.

    Finally: a candidate with the courage to ask the chronically ill and elderly to pay their fair share to reduce our national debt.

  • Mitt's Magic Underpants on August 13, 2012 5:46 PM:

    They would do their own grandmothers with a sponge and a rusty spanner if they got more tax cuts for their millionaire friends.

    Ad: "What won't Romney and Ryan do to give millionaires more tax cuts?"

  • Ron Byers on August 13, 2012 5:59 PM:

    You realize that people don't go on Medicaid until they have exhausted all of their resources, except if the applicant needs to be admitted to a nursing home andis married. Then the couple has to spend down half their resources, but the non-ill spouse does get to stay in her home and keep her car. Lots and lots of middle class people end up in nursing homes on Medicaid.

    Hey, we can't cut defense one dime and we have to slash taxes on the rich.

  • Adventuregeek on August 13, 2012 6:04 PM:

    With their seemly genuine desire to deny access to health care (not just health insurance) to the poor and elderly are teapublicans planning to repeal the laws that require ER's to treat everyone regardless of ability to pay? Otherwise the current crisis in ER care costs will grow to the point of bankrupting the hospitals. I mean isn't the logical next step is to make it legal to allow people to just die on the steps of the hospital because they can't pay for care?

  • Celui on August 13, 2012 6:08 PM:

    This entire Romney-Ryan budget issue is simply economic racism. Anyone who believes otherwise must think that the American future is due only to the uber-rich and their progeny. The current media / journalistic approach seems not to challenge any of this crap; is there not enough factual information out there, or do the media outlets owe too much to their corporate handlers? I'm afraid I've answered my own question.

  • Mimikatz on August 13, 2012 6:39 PM:

    If life expectancy drops, this takes care of both Medicare and social Security, more so the latter. Is that really the plan?

    I really do think that if R &R are elected Congress will remove the obligation for emergency rooms to treat people. When Reagan signed the law to prevent patient dumping, we were a more compassionate society. I really do think these guys are preparing us for the dog-eat-dog future they see ahead.

  • Diane Rodriguez on August 13, 2012 6:50 PM:

    I have a throbbing goose egg on my forehead from repeatedly banging it against the wall in frustration.

    The head banging is mostly media generated. They have already awarded Ryan a MENSA membership as well as the Ms Congeniality title. Dumbo has great manners. He doesn’t shout stuff like “you lie” at the President during the State of the Union. Instead he assesses the President’s mental capacity during public speeches, Obama is a “lazy thinker”. It’s so much more sophisticated than just saying he’s stoooopid just like the rest of those lazy, black people. Yeah - take that air raid siren disguised as a dog whistle.

    Even on a cursory reading, Ryan's Ayn Rand budget plan is spanking the ideological monkey. I have to wonder if Ryan is so devoted to the morally bankrupt, "I got mines" Rand because he can channel the atheist adultress from beyond the grave. Clearly, those ears get great reception. I bet the media will have him flying before long.

  • Neildsmith on August 13, 2012 6:55 PM:

    Given that the elderly and poor have been either trending GOP or not voting, I'm not sure there is much progressives can do to defend Medicaid. Perhaps, as anonymous points out in the first comment, it's going to take a few million sick and elderly people moving back in with their kids to get these people to stop voting for Republicans. Cutting these programs for a few years now may be the only way to save them for later.

    We can't fall for Ryans trick to keep current benefits and cut only for those under 55. If there be cuts, they should start in 2013.

  • rikyrah on August 13, 2012 7:38 PM:

    While the physical NUMBERS of people on Medicaid, the plurality are poor children..

    In terms of WHO GETS THE HIGHEST PERCENTAGE OF MEDICAID DOLLARS, it goes to two places:
    1. People in Nursing Homes
    2. Disabled adults

    I don’t have any problem with these two groups getting the BIGGEST CHUNK OF MEDICAID MONIES..

    but, I’m tired of Shanequa with her 3 children, or Rosa Maria with her 3 ‘anchor babies’, being made the scapegoat face of Medicaid, when the ACTUAL posterchildren for RECIPIENT OF MEDICAID DOLLARS

    is a picture of a WHITE Senior Citizen

    or a WHITE disabled adult.

    just tired of the Black and Brown being used as the scapegoats, when a whole lotta WHITE FOLKS need to be stepping up to the plate saying, YES, MEDICAID WORKS.


    Tell the son/daughter/grandchildren – do you have the $4-6 k/A MONTH that Medicaid pays for grandma’s nursing home? If not, get your ass to a voting booth.

    You folks out there with a disabled family member who gets healthcare from Medicaid – do you have the money to pay for that healthcare..then get your ass to a voting booth.

    it shouldn’t be this hard, but I think we’re just gonna have to be slapping folks upside their heads.

  • Sammi on August 13, 2012 10:10 PM:

    Amen. For a while now, I've been trying to sound the alarm about the impact of the MEDICAID cuts on the elderly and their adult children. The big talking point about Ryan's budget proposal is that it would not affect those 55 and over. I'm calling BS on that talking point because the MEDICAID cuts would throw lots of elderly people out of nursing home care and should really be called the "Bring your elderly parents and in- laws into your home Act". Im 44 yo and love my parents but if they were forced to move in with me and I was responsible for their care, I don't see how I could juggle a demanding job, care for my minor child,, and round the clock care for elderly parents with deteriorating health conditions.

  • Texas Aggie on August 13, 2012 11:04 PM:

    Two things about this are important because as one post mentions, people tend to think of Medicaid as a program for the "other," an impoverished member of a minority group.

    The first thing to mention is that cutting Medicaid will indeed affect a lot of middle class voters. The second thing to mention is that when Medicare is cut along with Medicaid, then a lot more middle class voters will be affected.

  • Dee on August 14, 2012 10:56 AM:

    Yes, children and disabled adults are such slackers.
    I'm sure my 42 year old nephew, who slipped on his basement stairs in January, hit his head and has been in a coma ever since, lays there every day and is gleeful over the Medicaid he's ripping off the taxpayers for. I'm sure he deliberately choose to work for a company that went out of business while he was in the ICU, causing him to lose his health insurance.
    Nobody can plan enough, or save enough, or work hard enough to be prepared for everything. Are we a country that Americans can depend on, or do we kick people to the curb when they need their Government the most?
    And Social Security, Medicaid and Medicare are not entitlements. I and every other American who has ever worked pays payroll taxes, unless you are deliberately working under the table to avoid taxes, or all your income comes from Capital gains.
    In that case - you'd be a freeloader on Government services.