• Medicaid! – One proposal really cuts it

    As many have noted, but the ACA President’s budget and the latest House Budget held Medicare growth to GDP+0.5%. If you need help, that’s the same amount.

    But the differences in Medicaid could not be more dramatic:

    That chart shows what, as Ezra Klein reports, “Rep. Ryan told the Congressional Budget Office his budget would do by 2030 (see page 13 of this CBO report).” (emphasis mine)

    The cuts aren’t going to health care for the elderly (regardless of what the commercials say). The cuts are going to health care for poor people. As the elderly also contain some poor people, there is still some overlap, but we shouldn’t kid ourselves as to who is bearing the brunt of our “sacrifice”.


    • Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) comprise a large part of our nation’s health care safety net. The people who utilize FQHCs and RHCs include the uninsured, Medicaid beneficiaries, dual eligibles and other low-income individuals. However, a disproportionate percentage of the income FQHCs and RHCs receive comes from Medicaid payments. Under the Prospective payment System PPS system are designed to help to offset the cost of care that the clinics provide to the uninsured.

      “For more than thirty years, Congress has recognized the importance of the health center safety net for people living in America’s medically underserved areas and those who have difficulty accessing affordable health care services. For more than a decade, Congress has also understood the relationship between adequate Medicaid reimbursements and a FQHC’s ability to maximize the care it provides to the uninsured through PHS Act grants. Because Medicaid is frequently a FQHC’s largest third party payer source, inadequate Medicaid payments have a direct impact on the appropriate use of Federal grant dollars to support care for the uninsured. “Understanding the Medicaid Prospective Payment System for Federally Qualifed Health Centers”, Koppen (2001)

      This means that States can’t assume that if they limit Medicaid eligibility and eliminate coverage for their low-income populations there will be another safety net there to catch them. Medicaid reimbursement are providing much of the funding that support that safety net.

    • I wish people would understand that Medicaid is not exclusively for the poor. Middle class people (mostly elderly but not always) who spend down and become eligible for Medicaid are not the same in people’s imaginations as “the poor”. If people understood that their homes could be on the line to pay for their parents’ care if Medicaid is cut, they’d probably start caring about those cuts. Right now it’s too easy for the callous and short sighted among us to write off Medicaid as help for “the poor”.

    • Thank you for posting this information. It amazes me that there are people out there that believe cutting Medicaid will solve anything. My daughter is on one of the Medicaid waivers. We were forced to remain below poverty level to keep her on Medicaid when she was younger. (We even had private insurance eventually but even with that it would gave been impossible to pay for all of her medical bills.) I am very passionate about this subject because of my daughter but also for everyone that could benefit from Medicaid coverage. One way or another we as a society will be paying for the uninsured. I would rather do it in a controlled way.

    • Looks to me like the “everything else” is being cut just as much as Medicaid.
      It amuses me that everyone is pushing the panic button on behalf of the poor, etc, yet I don’t see any proposals as to how we get out of this mess. Oh, sorry, I did see some posts about raising taxes on the rich. Yes, that should cure the problem.

      • You are willfully ignoring everything on this blog. Plus, I don’t think we’ve had any posts that are dedicated to raising taxes alone.

        • Dont feed the trolls Aaron.


        • I’ve read much of this blog the last 3 months, but not all. As a PCP, I do have to see more patients than ever before to keep the bills paid, so I don’t have time to peruse the internet for articles of support. Saying I’m ignoring “everything in this blog” is quite the exaggeration.

          Almost all the proprosals I’ve seen in this blog try to narrow the debt problem, but none demonstrate an ability to eliminate the debt. And there have been those posts that state the answer is to raise taxes.

          This nation wants the moon, but not pay for it. I really have yet to see solid proposals that gets this country out of debt, keeps a strong defense, allows for a reasonable retirement, and provides decent basic healthcare. That includes both Dems and GOP. Seriously, the only way this will occur is less debt production, and it will be hard and will not satisfy a lot of folks.

    • Doesn’t this post assume Ryan and the rest of the Republicans are able to repeal the ACA. Regardless of what is said, Ron Paul was right when he said his counterparts were being silly in thinking they can actually repeal the ACA, even if elected. (Of course, those were not the exact words he used)

    • An interesting chart. Keep in mind the figures are projections for the year 2030; they are to be taken with a grain of salt.

      I’d like to see these modifications of the chart:
      1. Add bars for the 2030 projections for President Obama’s proposed budget.
      2. Break down “Everything else” into Defense/National Security and Non-Defense/National Security.

      • Except this is what Paul Ryan told the CBO his plan would do. It’s what he hopes it will do. Maybe it won’t, but this is his intent.