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medicaid costs

It looks like massive cuts to Medicare won't be in the offing in budget negotiations (though benefit cuts could still be considered), Republican, and possibly some Democratic, sights have been on Medicaid as a bargaining chip. David Dayen writes about this possibility, since Sen. Kent Conrad has floated the idea that the budget bill would be passed by reconciliation.
Reconciliation, a provision of the 1974 Budget Act, allows Congress to change key elements of the budget as an adjunct to the normal legislative process. The process offers a fast track for spending or tax deals by avoiding procedural hurdles such as the filibuster in the Senate; debate is limited to 20 hours, and a reconciliation bill only needs a bare majority to pass. In both 1990 and 1997, Congress used reconciliation to pass deficit-reduction packages that reflected deals between Congresses and presidents of opposite parties. In the current impasse over federal spending, reconciliation could pave the way for the “grand bargain” that many in Washington have been hoping for: The House and Senate can pass separate bills that allocate and cut federal spending or revenues by a certain amount; then they can delegate the details of what gets cut and what revenues get raised to the reconciliation process....

As a political tool, though, the promise of reconciliation is a powerful one—and one that liberals should be worried about. House Republican leaders have insisted they will only agree to a budget deal if the vast majority of their caucus agrees with it, and any deal that would satisfy House Republicans would likely only squeak through the Senate with a bare majority. Senate liberals may wish to protect such safety-net programs as Medicare and Medicaid or want a more equitable ratio between spending cuts and tax increases. Through reconciliation, fewer of those liberals would be needed to sign on to the deal because that process requires only 50 votes (Biden would be the tiebreaker).

But there's some very good news on that front from the White House. Yesterday, White House National Economic Council Director Gene Sperling blasted the Republican plan and specifically the cuts to Medicaid that turning it into a block grant program would mean.

“I want to point out how isolated the House Republicans are,” he said. “Serious people doing serious discussions do not take an absolutists position that you cannot have a penny of revenue.”

He said Mr. Ryan has “put himself in a box” with his unwillingness to raise tax revenue. He said this forced Republicans to call for “very severe cuts” that if “explored” by Americans “they would not be proud of.”

Mr. Sperling attacked the House Republican proposals to overhaul Medicare and Medicaid, saying that the $770 billion in savings Republicans wanted from changing Medicaid would be unnecessary if Republicans would agree to roll back certain tax cuts.

“You can’t say to anybody who would be affected by that, that we have to do that, that we have no choice,” he said. “The fact is that all of those savings would be unnecessary if you were not funding the high income tax cuts.”

He also said, “From a values perspective, we should be very deeply troubled by the Medicaid cuts in the House Republican plan.” David Dayen has the full transcript, which concludes:

So when we say that there—that the tyranny of the math is that these—these—this Medicaid program, this Medicaid cut will lead to millions of poor children, children with serious disabilities, children with autism—elderly Americans in nursing homes losing their coverage or being—or—or having it significantly cut, we are not criticizing their plan. We are just simply explaining their plan.

One good reason for the White House to fight for Medicaid is the role it's expansion plays in the Affordable Care Act. The Republican plan for Medicaid and the ACA are simply incompatible (of course, the Republican plan would repeal the ACA, so for the GOP that objection is moot). But additionally, as Ezra Klein points out and the graph up top reflects, Medicaid is a really cost efficient—cheap—program. It can't substantially be cut and made cheaper, if it's going to cover the same number of people.

The Republicans have no qualms about booting 34 million children out of the program. Or the millions of working poor, or the more millions of seniors in nursing homes. I'm not sure where Sen. Conrad falls on that one, but it's very good to know that the White House is vehemently opposed.

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Comment Preferences

  •  Here's the deal (20+ / 0-)

    Most Medicare money pays for seniors who have exhausted their life savings and are in nursing homes.

    So if you cut back severely on Medicare, you either
    (1) Throw elderly people incapable of caring for themselves on the street, or
    (2) Eviscerate all care for poor people who aren't seniors

    Either way you're a ruthless asshole.

    In theory, there is no difference between theory and practice; but in practice, there always is a difference. - Yogi Berra

    by blue aardvark on Thu May 26, 2011 at 12:43:19 PM PDT

  •  Guess you'll have to find a new outrage (0+ / 0-)

    talking point.

    Or else you folks will have to do that insanely fail maneuver you tried at the end of your OBAMACUTSOCIALSECURITY fail: the "Obama did not say these exact words in this exact order!!!" bullshit.


    "I'm gonna go eat a steak. And fuck my wife. And pray to GOD"
    - hatemailapalooza, 052210

    by punditician on Thu May 26, 2011 at 12:47:15 PM PDT

  •  I'm still worried that our Democratic debt-ceiling (2+ / 0-)
    Recommended by:
    DaveW, jfromga

    team are going to agree to bipartisan Medicare cuts to avoid a financial crisis.

    I wish Obama would have the courage to stand up and say he will veto any bill containing Medicare cuts.

    Joan's point about our Health Program is right on.  We are going to need additional funds for Medicare, not even to mention the Doctors Fix, to the errors made in that Medicare bill decades ago.  There are cutes of 23% of something schedules, that we have to override each year.

    I fear Democrats may be walking into a collasal blunder.

    The means is the ends in the process of becoming. - Mahatma Gandhi

    by HoundDog on Thu May 26, 2011 at 12:48:28 PM PDT

    •  There's still time (5+ / 0-)

      I don't think the time is right yet for a veto threat on this one. I think Sperling's statement was a shot across the bow, with an implied veto threat possibly behind it.

      Smart politics, as I see it.

      There's plenty of time for a veto threat later. Doing one now takes the news cycle story away from Medicare as the issue, and TODAY, Medicare is a WINNING Democratic news story thanks to NY26. The R's are desperate to make the story about Obama, not them. A veto threat would completely shift the narrative to the veto threat as a procedural story, rather than Medicare as a policy story.

      But that's just how I see it.

      Progress is a continuum, not a light switch. Visit Leesburg Tomorrow.

      by Paradox13 on Thu May 26, 2011 at 01:01:13 PM PDT

      [ Parent ]

      •  Strategic thinking. I hadn't thought of it this (0+ / 0-)

        way, maybe you are right.  I was thinking the two were related.  Medicare cuts. But, you are right we are on an upswing, we do not wish to undermine.  A veto threat might do that.  Just to reassure a worried base, may not be worth, allowing the GOP to change the subject.

        The means is the ends in the process of becoming. - Mahatma Gandhi

        by HoundDog on Thu May 26, 2011 at 05:00:29 PM PDT

        [ Parent ]

    •  Would we oppose cuts targeting costs while (2+ / 0-)
      Recommended by:
      puakev, jfromga

      preserving benefits and eligibility standards?

      Cost savings should be on the table and should be actively discussed including in public forums.

      (If that's what Bill Clinton intended, he was right. If not, not.)

      We need to draw a distinction between looking for savings (on costs of care and unnecessary care) and cuts in benefits levels.

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Thu May 26, 2011 at 01:37:11 PM PDT

      [ Parent ]

  •  They lie; they get elected; they wreck (1+ / 0-)
    Recommended by:

    stuff, lather, rinse repeat.

    Why do people vote for 100% of nothing?

    Rec'ed Joan.

    The radical Republican party is the party of oppression, fear, loathing and above all more money and power for the people who robbed us.

    by a2nite on Thu May 26, 2011 at 12:50:26 PM PDT

  •  Kos, in math class you need (1+ / 0-)
    Recommended by:

    to show your work. I'd like to know specifically what 'adjusting for enrollees' health differences' means.

    •  Kos (0+ / 0-)

      is not the diarist.  

      •  It's a good question though (1+ / 0-)
        Recommended by:

        The table looks like its from the CBPP (Center on Budget and Policy Priorities) - which, granted, is a left-leaning think thank... but they're generally solid on the numbers.

        Still - I'm interested in how they do the age equivalencies, too and can't find it on the CBPP site.

        Can anyone help?

        I've got no doubt they explained how they did it - just want to see it.

        Full Disclosure: I am an unpaid shill for every paranoid delusion that lurks under your bed - but more than willing to cash any checks sent my way

        by zonk on Thu May 26, 2011 at 01:29:41 PM PDT

        [ Parent ]

    •  Good question (0+ / 0-)

      That's a good question, I was wondering the same thing.  Although, like bythesea points out, this isn't Markos' data.  It's from the CBPP and is referenced in Ezra Klein's article that is linked in the diary.

      I cannot find the details in the CBPP web site though after an admittedly cursory search.

      [Terrorists] are a dime a dozen, they are all over the world and for every one we lock up there will be three to take his place. --Digby

      by rabel on Thu May 26, 2011 at 01:30:04 PM PDT

      [ Parent ]

  •  Reconcilation Rules - ? (0+ / 0-)

    There are rules that must be followed, but I'm not sure what they are and where we stand.

    Can it be used once a year, once per Congress, once per budget ... or some other formula?

    Or, can it just be inserted into any new budget and used to pass that same budget.

    Get you get around the House by reconciliation.

    I know they used it to pass the ACA, and then were not able to use it again that  year.

  •  Now here's hoping someone takes a mic away... (1+ / 0-)
    Recommended by:

    Now here's hoping someone takes a mic away from Bill Clinton. Seriously I don't know what he is doing, yes bipartisan bills are wonderful but in this day when Congress is run by a trainwreck, and the Senate is still dealing with filibusters, you don't give a pat on the 'other team financial leader's' back and suggest working out a deal. Or for that matter suggest giving you a call to talk. I understand how politics is like football in some peoples minds, because really most of the time all these people both in the House and Senate are chums in real life, but really when this crap affects people like my parents and myself - I don't want Bill Clinton trying to give pointers on how to cut medicare.  I mean hell, he showed up on discussing "Health Care can't devour the economy." Which by the end of the day has foxnews trumpeting "Obama Dems Don't Listen to Clinton about Debt..."

    Seriously, someone has lost touch with the people.  And frankly I felt the same way when Hillary Clinton's Universal Health Care died on Bill's watch.  So what exactly is Bill Clinton doing? Other than of course living comfortably on his free for life healthcare, and cushy talking trips?  God I hope he's on our side... but I doubt it.


    •  It's past time for him to STFU. (1+ / 0-)
      Recommended by:

      I think the only way he can get headlines is by yapping GOP talking points. He planted some of the timebombs that are now blowing up our economy. Now he could at least have the humility and decency to just go fishing or whoring or whatever his passion is these days. The sooner he and his cronies are out of DC, the better off we'll be.

      Conservatism explained: Carrots for the rich and the corporate. Sticks for the workers and the poor. It really is that simple.

      by DaveW on Thu May 26, 2011 at 01:58:27 PM PDT

      [ Parent ]

  •  GOP Budget Plan (Ryan's TEOMAWKI) (3+ / 0-)
    Recommended by:
    tardis10, DaveW, jfromga

    would hammer the elderly not only through its "redefinition" of Medicare but also through its 'redefinition" of Medicaid:


    Under federal law, states generally must cover poor seniors who receive federal Supplementary Security Income (SSI) benefits. [8]  The federal SSI income limit for elderly individuals is about 76 percent of the poverty line, or about $8,328 in 2011.  (States have the option of providing coverage to seniors with somewhat higher incomes, and many do.  In 2007, a little more than half of seniors enrolled in Medicaid were optional beneficiaries.)  Approximately 6 million low-income seniors are “full dual eligibles” — people enrolled in both Medicare and Medicaid.  For those individuals, Medicaid fills the gaps in Medicare coverage, which these beneficiaries could not afford to fill on their own.

    For many of these seniors, the long-term care benefits that Medicaid provides (and that Medicare does not cover) are particularly critical.  An overwhelming majority of Medicare beneficiaries who live in nursing homes rely on Medicaid for their nursing home coverage.  Because the Ryan plan would require such severe reductions in federal Medicaid funding, it would inevitably result in less coverage for nursing home residents and shift more of the cost of nursing home care to elderly beneficiaries and their families. While states are unlikely to eliminate coverage of long-term care services altogether, it would likely be a target for substantial cuts when a state’s block-grant funding becomes inadequate because these services are expensive and constitute about one-third of total Medicaid expenditures. [9]

    Ryan Medicaid Block Grant Would Cause Severe Reductions in Health Care and Long-Term Care for Seniors, People with Disabilities, and Children

    Projected federal spending on Medicaid for the 10-year period 2012 to 2021 would fall by $1.4 trillion, a 34 percent decline. By 2021, states would receive $243 billion less annually in federal Medicaid money than they would under current law, a 44 percent reduction.

    Medicaid and the Uninsured
    House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing
    May 2011

    And since many (most or all) State's state and local tax systems are regressive in effective rate of payment compared to income, any shifting of tax burden down onto the State or local level would be just robbing low and middle income Peter to pay for elderly nursing home care of Paul.  

    We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

    by Into The Woods on Thu May 26, 2011 at 01:00:18 PM PDT

    •  Thanks for the comprehsive info. (0+ / 0-)

      I hope it gets widely seen. It deserves a place somewhere where it won't just scroll off into the memory hole.

      Conservatism explained: Carrots for the rich and the corporate. Sticks for the workers and the poor. It really is that simple.

      by DaveW on Thu May 26, 2011 at 02:00:33 PM PDT

      [ Parent ]

  •  I was struck (16+ / 0-)

    by how much the new NY 26 congresswoman talked about that revenue increases were necessary in order to reduce the debt.  If she was willing to campaign on that in a very Republican district, that should show most Democrats in 2012 that talking about raising taxes on the very wealthy and some businesses is not a bad idea.

    I think we are all conditioned to think that the American people will stop listening and vote for the other guy if you start talking about taxes.  But, for some reason, if you start talking about cutting THEIR benefits or raising taxes, they seem to think raising taxes on the wealthy might not be a bad plan :)

    If I were Democrats, this sentece would be my campaign thesis statement---'We either have to cut YOUR Medicare/Social Security or raise taxes on those making over $500,000 and cut tax breaks for oil companies.  You decide what you want us to do'

  •  They have taken an axe to Medicaid (7+ / 0-)

    in my state (AZ AHCCCS) and have curtailed funding for Ryan White, and I rely on both in my present condition to provide me even with meds to stay alive.  Without those, I will die.  

    Frankly I am scared.

    •  By 2021, GOP Budget Would Force 40% Cut (1+ / 0-)
      Recommended by:

      in eligibility in Arizona, according to the Kiaser Foundation.  

      % Enrollment Cuts in 2021 Under House Budget Plan
      Assuming Current Law Spending Per Enrollee and
      Proportional Reductions Across Eligibility Groups
      Arizona  39.6%

      The really bad news is that the projected impact on Arizona's enrollment is the 5th least impact among the states, with half of the states projected to have forced enrollment reductions of 50% or more.

      House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing  Figure 6

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Thu May 26, 2011 at 01:49:39 PM PDT

      [ Parent ]

  •  “From a values perspective..." (4+ / 0-)
    Recommended by:
    OldDragon, Egalitare, judyms9, Matt Z

    That's exactly what the Dems should say each time a Rep proposes to cut, delete or undermine a social program!
    Good thinking Mr. Sperling.

    'We can make the trains run on time but if they are not going where we want them to go, why bother?' Neil Postman

    by history first on Thu May 26, 2011 at 01:08:03 PM PDT

  •  If the Dems could get the WH message out (5+ / 0-)

    there in those clear terms---the GOP wouldn't have a chance.
    We need to pound it home!!!!

  •  By State - What if TEOMAWKI has come in 2000? (2+ / 0-)
    Recommended by:
    tardis10, jfromga

    What if Ryan's Medicaid Block Grant Had Taken Effect in 2000? Federal Medicaid Funds Would Have Fallen over 25% in Most States, Over 40% in Some, by 2009

    The block grant would start in 2013 and cap federal Medicaid funding at levels well below what the existing system would provide.  Federal Medicaid funding would be cut 35 percent by 2022 and 49 percent by 2030, according to the Congressional Budget Office. [2]  As a result, the block grant would sharply shift costs to states, beneficiaries, and health care providers over the next 10 years and the decades thereafter.  States would have to offset the federal funding shortfalls by substantially boosting their own contributions to Medicaid or using the greater flexibility that a block grant would provide to make deep cuts to eligibility, health and long-term care services, and provider reimbursement rates, as CBO notes.
    To help illustrate how states would likely fare under the Ryan block grant over time, we have estimated what the state-by-state effects would have been if it had been in effect between 2000 and 2009, based on the Ryan block grant’s specifications as outlined by CBO.
    Our findings show that:

     - States would have received $350 billion — or 21 percent — less over this period than they actually did.

     - In 2009 alone, the cuts in federal funding would have equaled an estimated $63.5 billion, a reduction of 29 percent.

     - While the Ryan block grant would have hit all states hard over the 10-year period, it would have produced disparate effects, with some states made substantially worse off than others.


    The CBO study referenced in that report can be found here:

    Congressional Budget OfficeLong-Term Analysis of a Budget Proposal by Chairman RyanApril 2011

    And some useful detail on the GOP's foundation for their Budget Proposal is contained in the the Committee report that accompanied it:

    H. Con. Res. 34

    Welfare Reform.
     The budget will build upon the historic welfare reforms of the late 1990s by converting the Federal share of Medicaid spending into a block grant that lets States create a range of options and gives Medicaid patients access to better care. [Through the 'generous' application of  Magic Block Grant Dust? ITW]  The budget proposes similar reforms to food stamps, ending the flawed incentive structure that rewards States for adding to the program’s rolls. [While contributing to the underlying economic fallout that drives people to depend on such programs for their food. ITW]  Finally, this budget recognizes that the best welfare program is one that ends with a job [I'll pass that along to those millions of elderly nursing home residents - the bulk of whose care is paid for by the Medicaid welfare program. ITW] : it consolidates dozens of duplicative job-training programs into more accessible, accountable career scholarships that will better serve people looking for work. ...

    One of the many questions that comes to mind is whether the Republicans know that in many states, 2/3 of the cost of nursing home care is paid for by Medicaid and whether they truly expect nursing home residents to get up out of their wheelchairs and go and get a job?

    We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

    by Into The Woods on Thu May 26, 2011 at 01:25:34 PM PDT

  •  My personal plan upon depleting most of my funds (0+ / 0-)

    is to give two hefty teenagers $20/ea. to boost aged me onto a Greyhound that goes to DC, where I will then pay two more kids to get me into a taxi that will deliver me to the steps of the Congress, where I will draw my last breath and let them figure out what to do with me when they find I have no ID.
     These buses filled with seniors that one sees on the highways, they may not be heading to the casinos; they may just be driving around looking for the right place.  

  •  What does the President really want? (0+ / 0-)

    You can't be for Medicare, Medicaid and Social Security and then have the liar and your staff-supplier Billy Clinton kissing Peterson and Simpson and Ryan.

    The DLC dance is on - Ryan is bad and we are just going to "reform" your benefits less. Be happy, suckers, and don't believe that all the campaign money comes from the same rich people, divided between GOP slugs and Dem traitors to the middle class.

  •  Medicaid isn't just for poor people anymore. (3+ / 0-)
    Recommended by:
    tardis10, jfromga, Matt Z

    The reality is that it becomes the last resort for all but the richest Americans who end up in long nursing home stays. It's bad enough that they have to impoverish themselves and their families in order to not die in the streets, now the GOP wants to take away even that pitiful last resort. We've reached a point in this country where every Republican vote is a vote for psychopathy made into policy. The sheer senseless meanness becomes more stunning and disgusting by the day.

    Conservatism explained: Carrots for the rich and the corporate. Sticks for the workers and the poor. It really is that simple.

    by DaveW on Thu May 26, 2011 at 01:50:01 PM PDT

  •  This is a positive (1+ / 0-)
    Recommended by:
    Matt Z

    sign out of the WH,  fairly strong language for them, and some good arguments about why Medicaid can't be cut.

    And seniors need to know that the Republicans want to cut Medicaid, and their families need to know.   Lots of grandma's and grandpa' out there that will be looking for new homes, who present challenges care wise that two working parent families simply can't meet.

  •  I'm confused (2+ / 0-)
    Recommended by:
    57andFemale, Matt Z

    I was told by many people here that Gene Sperling was the reincarnation of Andrew Mellon and that he wanted to turn America into a modern day version of a Charles Dickens novel.

    Are you telling me that these people may have been exaggerating or - gasp! - didn't know what the fuck they were talking about?

    "I used to try to get things done by saying `please'. That didn't work and now I'm a dynamiter. I dynamite `em out of my path." - Huey Long

    by puakev on Thu May 26, 2011 at 02:29:36 PM PDT

  •  There's a more effective argument against the cuts (0+ / 0-)

    2/3 to 3/4 of seniors in nursing homes are on Medicaid.

    Cut Medicaid and you throw them out into the streets.

    Ideology is an excuse to ignore common sense.

    by Bush Bites on Thu May 26, 2011 at 02:48:49 PM PDT

  •  Paying for your parents and grandparents (0+ / 0-)

    Younger people need to know that Medicare does not pay for nursing home care (other than a short bit of skilled care immediately after hospitalization) and that Long Term Care Insurance is very expensive and something their parents are not likely to have.

    Medicaid does pay for nursing home care but the eligibility rules and amounts vary from state to state so you might want to check into the details. We had an elderly relative who would have been entirely inelegible for Medicaid according to her state's rules had her small pension been just a tad larger.

    She ended up spending 12 years in a nursing home with no idea who she was. We could not have cared for her at home and had we been forced to pay the $100 a day cost for 12 years our finances would likely have been damaged to the extent that our children would have had to help out.

  •  No surprise Medicaid cheaper, it pays less (0+ / 0-)

    There should be no surprise that Medicaid is cheaper than private insurance.  Medicaid is notorious for the lowest payments to doctors of any program.  In many areas Medicaid recipients cannot find a doctor because the doctors will not accept Medicaid.  A smaller, but still significant percentage of doctors no longer accept Medicare (which limits what doctors can charge) and many will not accept Medicare assignment (which limits payments further).

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