A longtime dream of the conservative movement has been to dismantle Medicaid. Obamacare is the opportunity.
By Ryan Grim
WASHINGTON ? While the debate over Obamacare repeal focuses on insurance subsidies, coverage equity and tax cuts, a far more radical attempt is quietly underway to end the Medicaid program as we know it.
As currently structured, Medicaid guarantees a set of benefits to everybody who qualifies. Most people associate Medicaid with the poor and working class, but historically the program has spent as much or more money on elderly and disabled people who qualify. They use it to pay for things like nursing-home care that Medicare doesn’t cover.
The new version of the program would upend this arrangement. It would devolve Medicaid to the states and reimburse them using a predetermined formula that, as the Congressional Budget Office and other experts have concluded, would not actually keep up with the cost of care. As the federal contribution toward Medicaid eroded over time, states could make up the difference on their own or ? more likely ? they could make cuts in whom or what the program covers. The federal guarantee would be over, and with it, the Medicaid program as we know it.
That’s not an accident. If House Speaker Paul Ryan (R-Wis.) wanted Medicaid to keep up with the cost of providing coverage to those eligible, there would be an easy way to do it: leave the program as is. But Ryan has been salivating about targeting Medicaid most of his life, he said this week. When he’s speaking with conservative audiences, Ryan is upfront about the goal. “We’ve been dreaming of this since I’ve been around ? since you and I were drinking at a keg,” he recently told keg-party buddy Rich Lowry, editor of the National Review.
Speaking earlier with conservative radio host Hugh Hewitt, the two of them were practically giddy about the opportunity. “The Medicaid devolution, in capping, is the most significant entitlement reform of my 60 years on this planet,” Hewitt said, adding that he had just been talking with conservative economist Avik Roy. “Avik says it is 10 times more important than the welfare reform of 1996.”
“Oh, for sure,” Ryan replied. “Welfare reform is a $16 billion program. We’re talking about trillions in the end here in this program.”
The energy in his voice rising, Ryan got to the heart of the plan. “This is so much bigger by orders of magnitude than welfare reform, because ? let me just describe exactly what this bill does for conservatives. This is why I’m so excited about it, and this is why I think people need to see the forest through the trees. We are de-federalizing an entitlement, block-granting it back to the states, and capping its growth rate. That’s never been done before,” he said.
Read more
https://www.huffingtonpost.com/entry/paul-ryan-obamacare-medicaid_us_58d01716e4b0be71dcf6d5a7?ncid=APPLENEWS00001
No comments:
Post a Comment