Avik Roy is a Romney outside advisor on health policy who writes for Forbes. He seems like a decent guy. He helped me on a Washington Monthly story. I just believe he’s mightily, mightily misguided regarding the health impacts of Medicaid and other important subjects. (Avik and I have sparred many times before regarding Medicaid, and, on Twitter, regarding whether global warming is real, caused by human action, and demands a concerted policy response.)
The other day, Roy wrote a Forbes column called “The real ‘war on women’ is being waged by Obamacare.” It included the following:
A massive strain on tens of millions of women on Medicaid
In 2008, women accounted for three-fifths of all Americans enrolled in Medicaid, our government-run health insurance program for the poor. Medicaid is under enormous strain because its costs grow faster than state tax revenues do. As a result, state governments are cutting services to women on Medicaid, which already provides the worst health outcomes in the country.
Instead of fixing this problem by improving the existing Medicaid program, Obamacare severely worsens Medicaid’s structure, by shoving an additional 11 to 17 million people—disproportionately men—into Medicaid. This means that state governments will have to divert even more resources away from the women who are already in the program
Given the late campaign hour and the polemical purposes of that column, Roy can be forgiven for not going out of his way to detail the many ways the Affordable Care Act seeks to improve women’s health care and health coverage. Whatever one believes about the broader merits of health reform, ACA includes substantial provisions to provide roughly fifteen million women with health insurance, maternity coverage to 8.7 million women who buy their health coverage within the individual insurance market, and more.
Less excusable is his account of Medicaid finances itself. Roy doesn’t mention that the Affordable Care Act will finance 100% of the costs of newly-eligible recipients, a federal match that will taper down to 90% over time. Also unmentioned is the even-worse fact that Governor Romney and Representative Ryan embrace a budget that would severely reduce federal contributions to Medicaid. According to a recent report released by the Kaiser Family Foundation:
Under the House Budget Plan, federal Medicaid spending would be cut by $1.7 trillion over the 2013-2022 period. Of that total, $932 billion would come from the repeal of the ACA (assuming all states implemented the Medicaid expansion in the ACA) and another $810 billion due to the block grant. Together, these cuts represent a 38% total reduction in federal spending….
Governor Romney hasn’t gotten around to Etch-a-Sketching this one yet. I don’t believe he plans to, either. Block granting and cutting Medicaid–not health reform–would shift huge costs and risks onto individuals and state governments. In my view, these are the two worst ideas in health policy debate. This really is a structural threat to an essential, embattled program.