Romney–Ryan's Medicaid hangover

Published in The Siuslaw News, Opinion, Sept. 29, 2012
by Arnold Buchman

In this political season, we’ve heard a lot of rhetoric about the impact that the cost of programs protecting economically vulnerable individuals from health risks has had on a federal deficit still overwhelmed from unpaid-for wars, top-heavy tax cuts and a burst-bubble economy. Focus has been on Medicare, the major such program. The competing “solutions” for controlling its costs are the Romney–Ryan budget and the Affordable Care Act.

We know that ACA extends health care coverage to 30 million people currently without any health insurance. We know that repeal of ACA is central to the Romney–Ryan budget. What has gone largely unmentioned is that Romney–Ryan would nullify ACA’s expansion of Medicaid and curtail the services currently provided by this federal/state program to eligible seniors and adults whose income is less than 138 percent of the federal poverty level. ($11,170 for 2012), Romney–Ryan ads tell us that ACA has stolen from Medicare—“a program you paid for”—to provide health care access to people who have not paid for it. Putting aside the moral ambiguity of this assertion, it ignores that the effects of Romney–Ryan extend beyond Medicaid beneficiaries.

The complexity of these effects is detailed in a Kaiser Family Foundation issue paper, Its bottom line: Costs to federal taxpayers would be reduced by shifting the burden to state and local government taxpayers and to hospitals that rely on Medicaid payments to treat the indigent and uninsured that by law they cannot turn away.

Closer to home for many with an impecunious parent—perhaps afflicted with Alzheimer’s or other debilitating infirmity—who cannot live on their own or, for whatever reason, with their children, Romney–Ryan presents an immediate challenge. Why? Because Medicaid accounts for more than 40 percent of the nation’s nursing home spending. For many tax-paying middle-class children of an aging, tapped-out population, ensuring a parent’s access to health care suddenly will be complicated by having to grapple with paying nursing home charges without Medicaid assistance.

Safety net programs, including Medicaid, cost money. ACA emphasizes strengthening cost-saving preventative care and developing cost-cutting health care efficiencies. Romney–Ryan cuts costs by repealing the ACA, converting Medicare to a voucher program and changing Medicaid to a block grant program. These fundamental changes to the structure of health care financing would reduce federal spending. But they would also result in large reductions in enrollment and in payments to hospitals and other providers. In doing so, Romney–Ryan doesn’t reduce the needs or the costs. It simply shifts these burdens to state taxpayers. Unless we are prepared to leave the indigent, including our parents, out in the cold, these costs still will be paid—by you, me and our children.