Paul Ryan Nomination Has Huge Implications for Medicaid

The decision by the Romney campaign to tap Representative Paul Ryan for the Vice-Presidency will have implications for the health care advocacy community. This nomination is sure to make the debate over Medicaid a national debate, not just a state-by-state one.

This will happen because the Republican Campaign seems to be embracing the entire Ryan Budget. Here are some of the things that are in that budget:  

  • Medicare is turned into a single dollar amount voucher that inevitably will fall short of the inflation in medical costs.
  • Medicaid is turned into a block grant to the states and cut by about $800 billion over 10 years.
  • The entire Affordable Care Act is repealed.
  • Food stamps (SNAP) are cut 134 Billion over 10 years.

There is a lot more. The Congressional Budget Office has estimated that by 2050 the Ryan Budget would eliminate the entire federal budget except for Defense, Social Security, and health care entitlements. Yep, everything else. So if you are concerned about clean water, bridge repair, home heating, first responder support, Federal Emergency Management, housing, small business subsidies, farm supports, education for disadvantaged kids, Head Start, community clinics – or anything else, you will be out of luck if this budget is adopted and sustained by the national political system.

But it is the plan for Medicaid that will have the fastest and most massive impact on the U.S. health care system. How massive? Think 44 million additional Americans without health insurance, in a worst case scenario.

Medicaid serves around 60 million people, 10 million more than Medicare. Most current Medicaid recipients are low-income children and their mothers, but the costliest cases are severely disabled people, many of them seniors in nursing homes.

The ACA expansions of Medicaid would add about 11,000,000 more to Medicaid rolls.

Some politicians in both parties view Medicaid as easier to attack than Medicare because the latter serves seniors without regard to income levels. Medicaid serves only the poor who often lack the political muscle to protect themselves.

Bringing Medicaid into the national debate will cut two ways. On one hand, this may make the issue a partisan one where Democrats become more inclined to fight for it than has been the case in the past. On the other hand, Republican politicians who might be inclined quietly to accept the expansion of Medicaid may start to back away.

There is no clear way forward toward a better health care system that does not include a strong Medicaid program. The private insurance sector is unavailable to those at Medicaid eligible income levels. If there is no Medicaid expansion the cost of care for the poor in the hospital emergency room will continue to be shifted to all consumers. The health care system’s ability to bring effective prevention and primary care to low income consumers will vanish as a lost hope.

Many of the AJS partner organizations already participate in coalitions to protect Medicaid. Everyone needs to join in this effort. The Alliance and other organizations can help supply information and talking points about this vital program if they are needed.

Just be sure you are ready for an even more intense fight than you thought was coming before the Ryan nomination.

Bill Daley is the Federal Issues Policy Director at The Alliance for a Just Society.

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