• Medicaid! – Cut Medicaid and you cut health care for the elderly

    Gov. Romney and Rep. Ryan have been adamant that their Medicare proposals won’t affect people over 55. That may be true. But their Medicaid proposals sure will. A lot of health care for the elderly comes from Medicaid. We call those people “dual-eligibles”, because they qualify for both Medicare and Medicaid. Some dual-eligible are younger disabled people, but about two-thirds are 65 or older. The Kaiser Family Foundation reports:

    Dual eligibles as a share of total Medicaid enrollees ranged from a low of 10 percent in Arizona and Utah to a high of 26 percent in Maine, due to demographic differences and policy preferences across the states. Similarly, spending on dual eligibles as a percentage of total Medicaid spending ranged from a low of 18 percent in Arizona to a high of 59 percent in North Dakota.

    Lots of Medicaid money goes to the elderly. Cut Medicaid, and you likely cut some of that. Here’s more:

    One quarter (25%) of Medicaid spending for dual eligibles went toward Medicare premiums and cost-sharing for Medicare services in 2008. Five percent of spending for duals was for acute care services not covered by Medicare (e.g., dental, vision, and hearing services). Another 1 percent of Medicaid dual eligible spending was for prescription drugs, a percentage that has fallen significantly since coverage for nearly all prescribed drugs for duals was shifted from Medicaid to Medicare Part D in 2006. The remaining 69% of Medicaid spending was for long-term care services, which are generally not covered by Medicare or private insurance.

    That Medicaid money is going to Medicare premiums! It’s also going to actual care. Cut Medicaid, and you likely cut some of that.

    It’s about time someone pointed that out. The health care proposals of Gov. Romney and Rep. Ryan will absolutely impact some elderly people way earlier than a decade. Unless they’ve changed their minds again.

    @aaronecarroll

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    • Alternatively, as I’ve suggested, Ryan’s proposal might NOT affect seniors … if states eliminate all the moms and all kids from their rolls.

      To put it baldly, the seniors here are mainly White and poor. They’re part of the GOP base.

      The moms and kids are a lot browner. So, the GOP has a political incentive to cut their care. You know, there have been occasional attempts to crack down on the alleged hordes of illegal immigrants cheating the Medicaid system … you think those crackdowns were aimed at the seniors? Sound anything like the attempts to suppress minority voters?

      Btw, those crackdowns found perhaps a handful of beneficiaries who did not in fact meet the citizenship/residence requirements.

    • I find it interesting that the Democrats pounce on the cuts to Medicare inferring that all seniors will “suffer” under the Ryan plan; yet, they have this gold mine right in front of their faces and do nothing with it. As your column alludes too, these Medicaid cuts WILL negatively affect the seniors, and all poor, too! I don’t get it. I’m honestly starting to question whether or not these politicians have actually read Ryan’s plan (the Medicare & Medicaid section is only about 10 pages) or the CBO anaylis (17 pages).

      • “I don’t get it”

        Medicare is seen by the public as a program for all Americans, earned and paid for during their working lives, and effecting everyone, especially the white middle class.

        Medicaid, although as Aaron says spends most of its money on care of the elderly, is seen as a “handout” program for the undeserving poor — of course often visualized as people of color.

        For politicians, Medicare is pure gold, since it is a beloved program with many, many beneficiaries and would be beneficiaries who vote. Being for Medicare and accusing your opponent of being against it is politics 101.

        Medicaid is much more problematic. Supporting it requires stepping on the prejudices for large parts of the voting public, and explaining the subtleties of the program, as Aaron has done here, requires a level of complexity and “wonkishness” that is poorly tolerated by both the electorate and the media. This makes it risky as an issue for politicians.

        • Well said. I completed a public action a few months ago. I stood with portraits and signs about access to healthcare at the Supreme Court and Capitol .

          Anecdotally, I observed that if I kept some people talking long enough about their opposition to the ACA, they admitted more times than not that the uninsured did something “wrong.” “Those people” in the ERs….they didn’t have jobs, were maybe the wrong color and somehow they deserved their fate. The opposition worked harder and made sacrifices the uninsured were unwilling to.

          I was quite shocked at the level of stereotyping that went on. Still am. It is a complex issue in the American psyche that is only exacerbated by thoughtful discussion of Medicaid.

    • In addition to this effect on the minority of Medicare beneficiaries who are dual-eligibles, everyone on Medicare is also affected more directly by repealing the Obamacare provisions that are current Medicare benefits (like closing the doughnut hole, free annual wellness visits and screenings).

      Romney is comparing his plan to Medicare BEFORE Obamacare took effect, but that’s history. I wish the media would call him on this,as the proper comparison is with Medicare as it exists today, not as it’s existed in the past.