You don’t keep the Medicare promise when you bloc grant and cut Medicaid

My latest, in the Daily Beast.

Paul Ryan and Mitt Romney have been campaigning on Medicare–claiming that people over 55 and current Medicare recipients will be unaffected by their proposed conversion of Medicare from a universal comprehensive defined benefit to a variously-defined premium support program.

I’m not wild about these proposals—which certainly do not shield current seniors and near-retirees from ill-effects. In repealing health reform, Romney and Ryan would re-open the prescription drug donut hole and remove other benefits included in the Affordable Care Act, The New York Times reports that this would also raise average Medicare premiums by an average of $342 a year over the next decade, $577/year by 2022.

I’m far more concerned about what Romney and Ryan’s proposals would do to low-income elderly or disabled people, especially the nine million “dual-eligibles” who rely on both Medicare and Medicaid. This is the poorest, sickest, and most complex segment of the Medicare population. These vulnerable men and women account for about one-third of Medicare’s total costs. They also seem out of sight, out of mind, in this year’s campaign debate.

Paul Ryan campaigned in Florida by visiting the Villages, a rather upscale 25,000-acre retirement location whose website brags about residents’ high incomes and the area’s 29 executive golf courses. I wish Ryan would get out of the Villages, and visit some of Florida’s 400,000 dual-eligible seniors. His proposals to bloc grant and deeply cut Medicaid would hurt this population, would hurt state governments, and would inevitably hurt Medicare, too.

More from me, here in the Daily Beast.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

9 thoughts on “You don’t keep the Medicare promise when you bloc grant and cut Medicaid”

  1. You’re really understating the problem here. Even at the Villages, there are loads of Medicaid beneficiaries. Many rather wealth people benefit from Mediciad – especially children of old folks requiring long term care who would otherwise feel obligated to pay for their parents. Without any cost control measures or a hint that states would make up the 100 to 200 billion in promised federal funding cuts, millions of seniors will have to face the nightmare of burdening their children with the cost of their care.

  2. Ryan visited The Villages for one simple reason — it’s the best, highest concentration, of blindly loyal Republicans any place in the USA where the literacy rate is over 50%.

    I live in The Villages. It’s a terrific place to live in retirement. But I simply don’t discuss politics with my friends here. It would be like talking to a brick wall, with one exception — the wall would be mad at me.

    1. “But I simply don’t discuss politics with my friends here.”

      Thereby perpetuating the stereotype of ‘spineless liberal’.


      1. I’ll defend Ken Rhodes here. Discretion is the better part of valor. There’s nothing ‘spineless’ about declining to beat one’s head against a brick wall. If Ken were challenged on his views, and refused to defend them, that might be a sort of spinelessness, but that’s not at all what he said he does. He just said that he declines to get into discussions. Ken has to live with these people – I think he’s entitled to gauge whether there’s any possibility that debate would change their minds. Since debates rarely change anyone’s mind, I trust that he is making a well-informed and sensible judgment call on that score.

        1. Ummm… no. This comment is complete bullshit.

          There are many examples of societies in transition and it is noticeable how often the “status quo” gets preference, until it isn’t.

          1. So, Russell, are you planning to make the march on Rome (The Villages edition) any time soon? Inquiring minds want to know.

          2. Why, no Nick, I intend as history suggests is prudent, to fortify my estate, pay my, ahem, “bills”, and endure.

      2. I have to go with Ken here. We associate with people who are fairly intelligent, reasonably well educated, have interesting and varied backgrounds (some of which are downright fascinating and/or admirable,) and who are generally pleasant and likeable. They have worked hard, paid their dues (and their taxes,) raised families, and taken care of elderly relatives. In short, they are nice people to be around. And they only watch Fox news, they mostly listen to Limbaugh, and some of them love Caribou Barbie. They hate and despise Obama, re-circulate via Email and Facebook and in person all the old crap that’s been disproved many times (and still think that birth certificate is forged.) They believe all Democrats are stupid or evil, ignorant of the “facts,” and possibly Commies. They completely ignore any factual information you might send them to the contrary that refutes their firmly held ideas.

        There is no way…NONE…that anyone whose position is different from theirs can even carry on a civil and intelligent discussion with them about politics, never mind make a dent in their beliefs. They think and spout simple one-liners. If you find yourself in a community of any sort with them, and wish to have acquaintances to socialize with, you tolerate this garbage and keep your mouth shut. Usually on your tongue. You confine your personal efforts at education to people you know who are at least somewhat open minded, but who dislike anything political and generally know almost nothing about what’s happening and simply blame all politicians equally for anything they don’t like. These are often busy younger people who will at least listen and perhaps think about or research what you say, since you know more than they do and since you (one hopes) haven’t royally antagonized them by hammering them about it. And if you can, you contribute some money and/or time to candidates you support.

        Arguing with the people like the ones Ken mentioned is absolutely futile. You could have a silver tongue and be armed with every fact and figure you can think of, and it won’t do any good. The Fox crowd is completely impervious to facts, arguments, or anything else which doesn’t support their world view. It will only turn pleasant acquaintances, with whom you can share various enjoyable activities, into enemies which will ensure that your whole group will be divided into people who feel they have to take sides, and an entire little community of people who generally get along may fracture. And your blood pressure can only stand so much!

        Pick your battles.

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