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The Obama campaign is releasing this ad this week in eight states: New Hampshire, Virginia, North Carolina, Florida, Ohio, Iowa, Colorado and Nevada.

"It's one of the hardest decisions a family can make: realizing a nursing home is the only choice. For many middle class families, Medicaid is the only way to afford the care."
Like Jon Cohn, I'm hoping that this issue will come up in the vice presidential debate tonight. It should, because the Romney/Ryan plan to block grant Medicaid, comes primarily from Ryan. While much of the focus of in the presidential campaign has been on Medicare, it's the Medicaid cuts that will be truly devastating for seniors. As Cohn points out, "two-thirds of the money that Medicaid spends goes to that minority of enrollees who are disabled or over 65, because they are the ones with really big medical bills." And among those seniors depending on Medicaid is 70 percent of the nation's nursing home population.

To get a scope of what the Romney/Ryan Medicaid plan looks like compared to President Obama's, just look at this graph created by Austin Frakt and Aaron Carroll at the Incidental Economist. The dashed lines in the middle are Medicaid spending, blue for Obama, red for Romney. (Click on the image to view it at full size.)

Chart showing trajectory of health care spending under Obama vs. Romney through 2035.

The Romney/Ryan campaign says it's all about giving states flexibility to structure the program in the best way for their populations. The only option, when cuts are that severe, is to scale back coverage. Drastically. So states will have flexibility, the flexibility to either drop sick kids, disabled people, or the elderly. Some choice.

Originally posted to Joan McCarter on Thu Oct 11, 2012 at 09:48 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (25+ / 0-)

    "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

    by Joan McCarter on Thu Oct 11, 2012 at 09:48:11 AM PDT

  •  Many folks my age (62) (13+ / 0-)

    are dealing with the lack of employment and/or college bills for their children and the cost of medical care for their aging parents.

    I'm lucky -- no children -- and a mother who right now is in better health (with excellent medical coverage at 86) than I am.   Her worry is that she will spend down her kids' inheritance to pay for extended care later.  All of us told her it is her money and assets -- not ours.  But in the end, as I found with an elderly client, everything goes in order to get on Title 19.  

    That being said -- Title 19 is a safety net and you don't have to end up in a horror hotel.  My Mom prefers to die at home -- possible with home hospice when the time comes.  

    Those of us who are of an age with aging parents, really do need to have a conversation with them.  What will be their options.  What can we manage to help.  Most of us no longer live in those triple deckers designed for 3 generations.

    Only Biden will be able to assure us if the question is asked.  

    " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Thu Oct 11, 2012 at 09:56:19 AM PDT

  •  45,000 people dying each year form lack of ins. (5+ / 0-)

    isnt enough deaths for Romney.

    i swear there is a conspiracy to make America into a third world country. and i know no conspiracy theories her at DK.
    but is greed all there is behind this?

    "With malice toward none, with charity for all..." -Abraham Lincoln not a modern republican

    by live1 on Thu Oct 11, 2012 at 10:04:13 AM PDT

    •  Yes it's just greed (3+ / 0-)
      Recommended by:
      COBALT1928, Shippo1776, PinHole

      Don't underestimate greed as a motivator. It's been the driving force of the elite for a long time.

      “Experience declares that man is the only animal which devours his own kind, for I can apply no milder term to…the general prey of the rich on the poor.”  -Thomas Jefferson

      "This country will not be a good place for any of us to live in unless we make it a good place for all of us to live in."  -Theodore Roosevelt

      "Aristocrats fear the people, and wish to transfer all power to the higher classes of society."  -Thomas Jefferson

      Condemned To Repeat It blog

  •  shove "Go to the ER" up their asses (10+ / 0-)

    "We don't let people die because they don't have insurance"...except

    Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.
    Remind voters that "Obamacare covers X, Y, and Z and helps, Q, R, and S in these ways."

    Remind voters that more can be done to ensure that every American is entitled to health and happiness and not just a trip to the ER when your health has spiraled out of control.

    But I, being poor, have only my dreams; I have laid my dreams under your feet; tread softly, because you tread on my dreams. – Yeats

    by Bill O Rights on Thu Oct 11, 2012 at 10:26:46 AM PDT

  •  Oh, wouldn't it be loverly! (6+ / 0-)

    Now that Miittens has doubled down on his ER policy for the indigent, I think Joe could mop up the floor with this buffoon running mate.

  •  What they don't tell you (2+ / 0-)
    Recommended by:
    mcmom, COBALT1928

    Is that when Medicaid pays for a nursing home, most states have a right to go in and recoup costs from the person's "estate" when the spouse dies - meaning, if there is a family home, it is forced to be sold to pay the state.  Meaning that many middle-class and lower-middle-class families, whose one asset is a modest paid-for home, lose the ability to pass that down through generations, if that is their choice.

    The object of persecution is persecution. The object of torture is torture. The object of power is power. --George Orwell

    by jgkojak on Thu Oct 11, 2012 at 01:04:21 PM PDT

    •  In at least some states... (0+ / 0-)

      ...I think one can mitigate this, with some advance planning, by putting assets (esp. the house) into an irrevocable trust.

      (I am not a lawyer and don't play one on TV and have never been involved in creation of such a trust -- so I could be completely wrong!)

      •  My highly educated parents have tried this (0+ / 0-)

        My dad has early onset Parkinsons-- so
        1) since he was Dx'd at age 38, he could not get any long-term care insurance that was affordable on his teacher's salary (or disability insurance)

        2) He lost a leg from MRSA in the hospital, and eventually needed nursing home care through Medicaid -- my mom tried everything she could and worked with an attorney and the only way to protect assets would be to divorce my dad - which of course she will not do.

        And no, the trust thing only works if you do it several years prior - but we had no idea my dad would lose his leg several years prior.

        The object of persecution is persecution. The object of torture is torture. The object of power is power. --George Orwell

        by jgkojak on Sat Oct 13, 2012 at 12:53:36 PM PDT

        [ Parent ]

        •  Indeed... (0+ / 0-)

          ...it doesn't work in premature disability cases as most people are unwilling (nor is it likely wise to do so usually due to likelihood of involuntary divorce etc) to make such a commitment early in life.

          As far as not being willing to divorce, frankly, that's usually just a religious choice - in reality, it's just paper and a legal issue. But, it's smart to do and it's destructive to let personal notions of what a piece of paper means overrule rational economics.

          One doesn't have to like the hand dealt. One might think the world should be different. But that's what one has to play and it's, frankly, absurd to act against one's and one's loved one's self interests due to some variable notion of "morality".

          I'm intrigued by "of course she will not do". Why? Almost always, divorcing in a case like this is best for all. Why make two people suffer for some notion of "morality". It's NOT moral to make decisions on principle which harm all involved.

  •  this should be a major topic (7+ / 0-)

    I'm hoping they spend a much of the debate on healthcare issues.  This certainly brings in the debacle of the whole Ryan budget as well.  Maybe, this time, there will even be a question on female health issues away.  Romney and Ryan certainly opened the door to full discussion the past couple of days.

    "Son, if you really want something in this life, you have to work for it. Now quiet! They're about to announce the lottery numbers." Homer Simpson

    by SanAntonioKrusty on Thu Oct 11, 2012 at 01:04:52 PM PDT

  •  Great Point. (1+ / 0-)
    Recommended by:
    COBALT1928

    Most people are unaware that Medicare does not cover long term nursing care -- only Medicaid pays these bills, if you're eligible. This is often devastating to the children of the elderly needing such care, and results in such weird shit as the transfer of assets to allow for eligibility. Cuts to medicare would leave these seniors in the care of their relatives. Even the white-right would have a problem with this.

    "Force is as pitiless to the man who possesses it, or thinks he does, as it is to its victims; the second it crushes, the first it intoxicates.” Simone Weil

    by chuco35 on Thu Oct 11, 2012 at 01:11:02 PM PDT

    •  Most states won't allow assests to be transferred (1+ / 0-)
      Recommended by:
      PinHole

      within a certain period before medicaid coverage states to prevent that sort of thing. That way you can't just put grandma's house in your name to get her medicaid. When my grandmother needed to be put in a nursing home because of advanced Alzheimer's, my grandfather was forced to spend down their savings to get to the medicaid threshold, which worked out only because they had separate bank accounts. If they had had all of their money pooled in one account, they would have been fucked.

  •  States like Massachusetts v New Mexico (3+ / 0-)
    Recommended by:
    PinHole, Mr MadAsHell, hester

    People seem to forget that the reason "allowing states to manage" stuff is a dogwhistle for killing it.  It comes from the Civil Rights era, an echo of the Confederacy.  

    Sure, state like Massachusetts or New York or Washington State have enough economic power with a large enough population that is prosperous enough that they could handle taking on problems like health care as a state.

    But what about states like New Mexico, or Utah, or Mississippi? or any other state where the population is mostly struggling?

    Those state would have to depend on a national system, with the ability to pool resources across the entire US population, otherwise they just would not be able to must the economic oomph.  In New Mexico, there are people attempting to the the legislature to enact a state health care law that is close to being a real single payer system.  But with a governor that would veto any such thing instantly, and with a large number of Republicans in the legislature, the likelihood is not good.  The practical ability to handle the administration and funding of such a thing requires a level of competence that you mostly see with larger populations.  

    Even if one state succeeds through sheer determination, the problem is that many states would become places that the idea dies in.  

    Yeah,  let's elect people who believe in dogwhistling.  

    Let's pretend that every state has the capability that the states with the best jobs and the best educated populations have.  

    Why are the blue states blue?  They are places where there are more people, and more people who have a level of prosperity derived from education and yes, collective action.

    hope that the idiots who have no constructive and creative solutions but only look to tear down will not win the day.

    by Stuart Heady on Thu Oct 11, 2012 at 01:15:31 PM PDT

  •  Mitt Romney: (4+ / 0-)
    Recommended by:
    COBALT1928, PinHole, exMnLiberal, rlharry

    "Nobody dies from lack of health insurance." Of course not, they just die from lack of medical care.

    The definition of INSANITY: Voting Republican over and over and over and expecting the economy to get better.

    by pollbuster on Thu Oct 11, 2012 at 01:16:27 PM PDT

  •  I can handle a Romney Presidency, but... (2+ / 0-)
    Recommended by:
    PinHole, rlharry

    It's some of my loved ones who depend on medicaid who can't.  If I could ask Mitt or Ryan a question I would SCREAM at then for letting their ideology and/or general heartlessness hurt people who are already struggling so much.  

    so long and thanks for all the fish

    by Anton Bursch on Thu Oct 11, 2012 at 01:21:02 PM PDT

  •  The featured ad didn't thrill me (1+ / 0-)
    Recommended by:
    rlharry

    It seemed run-of-the-mill and easy to tune out, despite the fact that I will be facing the nursing-home dilemma with my own parents all too soon.  

    Obviously our side had the high ground on this issue.  But it needs a harder punch.

    "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

    by lgmcp on Thu Oct 11, 2012 at 01:22:52 PM PDT

  •  I'm PinHole, (1+ / 0-)
    Recommended by:
    rlharry

    and WE approve of this message!  

    Because of not having children, we have no built in care back-ups.  The safety net is important to us.  We looked after 3 elderly relatives in their last years - who is going to look after us?  

    Nursing homes and other care locations must have enough money to operate with fair wages and care standards.  Our county is currently trying to privatize the co nursing home.  

    After a life-time of being productive and having some money socked away, we know it can dissolve in an instant.  So, yes, we are not ashamed to be part of Willard's 47% and will vote accordingly.

    And we know their are many more out there who are closer to the edge than we are.  We don't want to see any more people out on the streets or in substandard care situations, even if we can manage to keep our noses above water.  

    What heartless, mean people, too many of the Republicans are!    

  •  Ironically (2+ / 0-)
    Recommended by:
    PinHole, rlharry

    President Obama spent a lot of time in the first debate talking about Medicaid cuts.  He didn't specifically tie it to nursing home and the elderly and disabled enough (or at all?)

    The GOP: "You can always go to the Emergency Room."

    by Upper West on Thu Oct 11, 2012 at 01:24:19 PM PDT

  •  Was watching the Hallmark Channel (1+ / 0-)
    Recommended by:
    PinHole

    Little House on the Prairie re-runs, and this ad came on. Certainly targeting the right demos

  •  And don't forget that under Obamacare, (2+ / 0-)
    Recommended by:
    rlharry, willyr

    the rest of us who don't qualify for insurance plans at work or are too poor to buy our own policies are supposed to be put on the Medicaid program.

    THAT is why they want to block grant and dismantle it. THAT is why Republican governors are refusing to implement it. They hate the poor.

    The fact that doing this would hurt older people in nursing homes probably never even occurred to them in their blind hatred for the poor.

    The year 2014 -- and full implementation of Obamacare -- is creeping ever closer, and Republicans don't want to allow anyone they deem unworthy to get any health care for free. Block granting Medicaid not only hurts older Americans in nursing homes and poor children. It shuts off access for the rest of us to any hope of medical care.

    "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

    by Brooke In Seattle on Thu Oct 11, 2012 at 01:26:11 PM PDT

    •  Block granting has been a GOP wet dream for years (1+ / 0-)
      Recommended by:
      rlharry

      They can yell about giving the states "freedom" to be innovative with federal dollars and then turn around and use their medicaid block grant to plug the gaping hole in the state budget for dropping corporate taxes to 0.

  •  My mother is a deranged psychotic. (2+ / 0-)
    Recommended by:
    msdrown, exMnLiberal

    This is not a new development, dads Alzheimer's is. Being the only liberal in a deeply republican family I have a health care plan if Romney (god forbid) gets elected. If the time comes, I ask for a show of hands for who voted republican. Those with raised hands get the parents (including mom). They want to vote away the parents health care, they can shoulder the load.

    "And while it was regarded as pretty good evidence of criminality to be living in a slum, for some reason owning a whole street of them merely got you invited to the very best social occasions."

    by Shippo1776 on Thu Oct 11, 2012 at 01:28:41 PM PDT

  •  THe real debate (0+ / 0-)

    The Romney Ryan campaign is encased in a festering stew of lies, and Paul Ryan will show it again tonight against the vice president. It is time for Biden to play hardball with a GOP ticket that will kill Medicare, kill big Bird and kill millions of Americans by denying them healthcare. Voters need to hear the truth about the GOP ticket, or else they might actually win this thing. Ryan is no mainstream politician. And his past is filled with instances of feeding from the public trough when it suits his financial and political aspirations, while simultaneously condemning the poor and middle class to cold austerity measures. This ticket is a phony.  -  progressive

  •  Fingers crossed... (0+ / 0-)

    I'm a little nervous that they are going to spend too much time on Lybia.  Look, it was teribble what happened and we need to fgure out how to do a better job of preventing it but there's an ongoing investigation so the finger pointing and making it a partisian issue is not tha t helpful.  

    Even though the extent of Paul Ryan's foreign polcy experience has been to approve budgets with millatry spending in them, I actually think that he is going to want to talk about it more than domestic issue.  He knows that his budget is not popular at all outside of the GOP.  If I were Biden I would hammer him on foriegn policy and then make sure that I'm exposing just hour radical his budget and views on abortion are.  

  •  Joe needs to ask Ryan about the meeting he (2+ / 0-)
    Recommended by:
    msdrown, exMnLiberal

    attended on the night of President Obama;s  inauguration. Ask him about it every time it comes up about Obama not getting bipartisan support for his bills.

    I don't know what consciousness is or how it works, but I like it.

    by SocioSam on Thu Oct 11, 2012 at 01:40:16 PM PDT

  •  Best zinger: and THAT's what Ryan thinks is ... (0+ / 0-)

    ... freedom

    Freedom for the states - almost all already in considerable financial binds of their own - to drop recipients and potential recipients somehow constitutes freedom for patients? What, thereby unfettered to any realistic health care options?

    Obama and strong Democratic majorities in 2012!

    by TRPChicago on Thu Oct 11, 2012 at 01:41:47 PM PDT

  •  I think we need to adjust the ad strategy (0+ / 0-)

    There was a poll not that long ago - before the debate - where the conclusion was that Romney's negative ads against Obama were ineffective because people assumed that Romney was taking Obama out of context, but Obama's negative ads towards Romney were more effective because people didn't like Romney.

    Then people saw the debate.  And if you were a low-information voter who was just tuning into the campaign, Romney came across as likeable.  

    I think that the barrier for Obama's negative ads is much higher now.  So there is a group of people (the 3% or so of people who shifted their opinion in the last week - meaning a 6-point swing, or less than that if you think the swing was smaller).  These people are persuadable - they did just change their mind.  These people either see Obama as weak, Romney as likeable, or both, based on debate performance or coverage afterwards.

    This ad would have been freaking awesome 2 weeks ago.  Now?  I think it will land with a dull thud.  Better to run it - but is there a way to have negative ads that use Romney's likeability against him?  

    One that I want to see is that Romney said he wouldn't pass abortion law.  Then instead of going just into the past, pointing out that 2 hours later his campaign reversed itself.  Romney will say something out loud to get quoted and look moderate, but then he will call Tony Perkins to assure him everything is fine and it's just a cover.  Something that gets people not to trust this likeable moderate Republican who was a successful governor (which you would think was the case if all you saw was the one debate.)

    Then - after debate #2 when Obama wipes up the floor with Romney, pile on.

    Meanwhile - ground game - get our voters to the polls now and get their votes locked in.  Hopefully these 3% who were persuadable aren't voting early until we get to them to change their minds back.

    -Fred

    Democrats *do* have a plan for Social Security - it's called Social Security. -- Ed Schultz

    by FredFred on Thu Oct 11, 2012 at 01:56:43 PM PDT

  •  For obvious reasons, Joe Biden is the obvious (0+ / 0-)

    person on the ticket to go after the other ticket on issues that concern older people, namely Social Security, Medicare, Medicaid and health care. One, he's been going after them on these issues for months and has been talking about these issues for years. Two, he connects with older voters better than Obama, both because he himself is older and because he comes off as more of a regular guy. Three, he's a lot older than Ryan, setting up a situation in which a young jerk tries to take down grandpa. And four, he's the designated "bad cop". Or, more accurately, "cranky older cop you don't want to mess with".

    I.e. what Clint Eastwood tried to play yet failed at so miserably.

    "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

    by kovie on Thu Oct 11, 2012 at 01:59:20 PM PDT

  •  My Mom is in this position right now. (1+ / 0-)
    Recommended by:
    exMnLiberal

    She ran out of money just last month and had to go on medicaid to cover her care in assisted living.  She will be 91 years old in a few weeks and has been diagnosed with Alzheimer's disease last year.  

    She worked hard her whole life.  My father was a WWII vet who lost a chunk of his leg, fighting for his country in the Marshall Islands.  Despite a profuse limp and great pain he worked and supported his family of five children and a wife until he died a premature death at the age of 52.  My Mom worked and kept our heads above water until we were all adults.

    When living on her own got too hard my mom sold her home and lived off of that money and her savings  until it ran out just last month.  So Mitt Romney thinks my parents, and especially my Mom are part of the 47% that doesn't take responsibility for their life.

    Gee Mitt, sorry my Mom hasn't  died more quickly for you.

    "Undermining Americans' belief in their own institutions of self-government remains a prime GOP electoral strategy." — Mike Lofgren

    by churchlady on Thu Oct 11, 2012 at 02:34:39 PM PDT

  •  Close to Home (0+ / 0-)

    The Romney Ryan Medicaid cuts hit close to home.  Without Medicaid, I honestly don't know how my family could have taken care of my mom who had significant health issues from Parkinson's Disease.  Her deteriorating condition was impossible to address even with home health care.  During the last 10 years of her life, we were so fortunate to find a wonderful private nursing home where she got excellent care.  She paid down her funds to the point that she qualified for Medicaid, and  luckily the home reserved several "beds" for Medicaid patients.  Had it not been for this, I don't know how we could have taken care of her ever increasing medical/physical/living needs.    It was hard enough seeing my once vibrant, very intelligent, artist mom waste away from this horrible, debilitating disease--but it would have been even more heartbreaking had we been unable to provide her with the care she needed.  

    "We have facts on our side. They have propaganda on their side."

    by rlharry on Thu Oct 11, 2012 at 03:31:51 PM PDT

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