Blue Mass Group

Reality-based commentary on politics.

Federal House Republican Budget: Disaster For America. Worse For Massachusetts

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Massachusetts would be disproportionately impacted by the Medicare cuts. As a relatively high-cost state, and with a major concentration of academic medical institutions that get extra Medicare reimbursements to allow them to teach the next generation of physicians, Massachusetts is more dependent on adequate Medicare rates than most states. The House Republican “shrinking voucher” plan would end up as insufficient assistance, leaving seniors with enormous costs and no way to pay.

Repealing the ACA would stop progress in Massachusetts health reform. We would also lose the additional federal support Massachusetts needs to remake our delivery system to save costs for everyone and improve the quality of care.

But we want to concentrate on the impact of turning Medicaid into a block grant program, which would whack Massachusetts much harder than other states. State analysts estimate that the Republican budget would mean over a billion dollars of federal support lost to Massachusetts every year.

The Republican proposal fundamentally misses who Medicaid helps. Klein again:

Ryan’s op-ed introducing his budget lists Medicaid under “welfare reform,” reflecting the widespread belief that Medicaid is a program for the poor. That belief is wrong, or at least incomplete. A full two-thirds of Medicaid’s spending {the Massachusetts figure is 62%} goes to seniors and people with disabilities – even though seniors and the disabled are only a quarter of Medicaid’s members. Sharply cutting Medicaid means sharply cutting their benefits, as that’s where the bulk of Medicaid’s money goes. This is not just about the free health care given to some hypothetical class of undeserving and unemployed Medicaid queens.

Blogger Matt Yglesias adds to this point: “Meanwhile, in terms of the “welfare” aspect of Medicaid by far the largest set of poor people it covers are poor children. Is Ryan’s view that these kids should have worked harder to have rich parents?”

The CBO’s sober analysis (pdf) acknowledges that the plan is not about saving money, but shifting costs onto states: “the large projected reduction in payments would probably require states to decrease payments to Medicaid providers, reduce eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more themselves than would be the case under current law.”

For Massachusetts, this cost shift would hurt people hard:

  • The block grants would be indexed for regular inflation, rather than being indexed for medical cost inflation.  As a result, federal funds would decline sharply, as medical costs grow faster than overall prices. Note that this budget trick would do nothing to actually control the cost of medical care, given that Medicaid is already one of the least generous payers in the state.
  • The block grant would be indexed for population growth, rather for enrollment growth. This means that federal support would be unavailable precisely when the residents of Massachusetts need it most – in times of economic distress when the caseload grows much faster than the general population (like the last three years)
  • The cuts would end any hope of restoring Medicaid reimbursement levels to match the cost of care. Chapter 58 included the goal of increasing Medicaid payment rates to roughly 95% of costs. However, budget shortfalls due to the recession intervened, and rates have been cut in many instances, rather than increased. The promised increases would be impossible under the block grants.

    • Yesterday, Governor Patrick joined 16 other Governors in sending a letter to Congressional leaders (pdf) opposing block grants, saying it would severely undercut our ability to provide health care to our residents and adequately pay providers.

    We need to join Governor Patrick in letting our leaders know that this slash-and-burn is bad for Massachusetts.

    Brian Rosman, Health Care For All

    Crossposted from A Healthy Blog

      

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    Comments

    1. So now the Democrats are the party of no. The CBO budget models predict a complete meltdown of the economy in the 2020s if we do nothing.  The obama budgets have the federal government spending over three times the projected size of the economy by 2050.  We are on a path to financial ruin.  

      • Oh, it’s the Democrats who are “the party of no”?

        <

        p>Consider these facts about Rep. Ryan’s “courageous” budget:

        <

        p>(1) Not only does it say “no” to raising any taxes whatsoever, it actually cuts them for businesses and the wealthy.

        <

        p>(2) It says “no” to cutting anything from defense spending. Nothing!

        <

        p>(3) All of the cuts instead come from social programs, mainly serving the elderly and the poor.

        <

        p>(4) The proposal relies on some absurd projections, including that the plan would reduce unemployment to 4% in 2015 and 2.8% in 2021.

        <

        p>If we are “on the path to financial ruin,” as you claim, then you shouldn’t like Rep. Ryan’s budget proposal. It’s reads like a greatest hits of conservative proposals dating back decades, does little to actually balance the budget (particularly given its wildly optimistic unemployment projections), and does its meager budget balancing almost completely on the backs of the poorest and must vulnerable.

        <

        p>It’s a complete joke, and ought to be treated that way.

        • I thought Ryan would skewer some conservative sacred cows, including taxes.  At the very least, it is a step more than a proposal to cut spending on some stuff, and to cut taxes.  I was likewise disappointed with the speed that our ordinarily ponderous president sent the Simpson/Bowles report to the circular file.

          <

          p>The Democratic plan– increase spending on everything and raise taxes, is likewise unresponsive to the underlying issue.

          <

          p>The reality is that, eventually, cuts like those in thus budget AND tax hikes are coming.

          • I’d agree with you that tax hikes and budget cuts are coming (and are necessary), but not “cuts like those in this budget.”

            <

            p>As I stated before and you stated here, Rep. Ryan skewers no conservative sacred cows. Defense is left untouched, which is really quite ridiculous given the percentage of the budget defense represents.

            <

            p>While certainly Medicare/Medicaid need to be addressed, and (relatively small) changes in Social Security should be considered, Rep. Ryan’s plan doesn’t try and address the underlying issue health care costs — he simply converts Medicare into a voucher program and Medicaid into a block grant program, both of which have been long-time conservative goals.

            <

            p>However, if anything, this will increase costs — assuming Congress won’t allow seniors to literally be thrown out on the streets (which, under pressure, they probably won’t). That will mean increasing the vouchers and the block grants over time through an overly complicated system, while losing the governmental leverage the single-payer systems use to cut health care costs. This is a recipe for either contributing to rapidly escalating health care costs on the government, or dropping millions of elderly and poor from any and all coverage — which will increase health care costs over the long-term.

            <

            p>In short the Ryan “plan” in nothing more than a cobbled together mix of questionable and even counter-productive conservative goals. I don’t see what’s so “courageous” about a conservative Republican introducing a plan that (1) cuts taxes on businesses and the wealthy, (2) maintains defense spending levels, and (3) cuts social welfare programs. That pretty much sounds exactly like what you’d expect from a conservative Republican.

            • Eighteen months ago, the Republicans began to gain momentum in what turned out to be a complete rout of Democrats because they successfully convinced people that Obamacare threatened Medicare.  

              <

              p>This proposal in fact abolishes Medicare, and replaces it with healthcare exchanges and some other bullshit that smell a lot like what we non-elderly are supposed to just love about Obamacare.

              <

              p>How do the Democrats defend that?

              <

              p>I denounce this proposal because it would abolish Medicare, which everybody loves.  (thunderous applause)  It would replace Medicare with Obamacare, which I previously described as wonderful, but now acknowledge to be awful. (crickets)

              • Will the new system please let us edit a comment?

                <

                p>Contd.:

                <

                p>How do Republicans support it?

                <

                p>They got a lot of “abolish the government, and hands off my Medicare” votes last September.  They got them all riled up and got the votes, but how can they possibly deliver anything satisfactory to these people?

                <

                p>Dems should do what they can do to “take the proposal seriously”– get hearings, whatever, air it out,  and then use that to turn the tables.

                • and that you are purposely confusing parts of the Affordable Care Act to make it all about insurance exchanges.  Private insurance and Medicare is completely different and had different parts within a global health care act.  What does Medicare have to do with Privates in the Act?  Explain it to me.  It doesn’t have anything to do with it, so I have no idea what you are talking about.  Makes no sense.

      • The entire conservative enterprise has been about shifting the burden of social programs from the federal government to state government and finally to local government. That’s what Grover’s bathtub looks like in real life: fiscal burdens shifted to where they can’t possibly be sustained.

        <

        p>Now, you want the country to do what the GOP wants because otherwise there will be a financial meltdown. You guys are the reason we’re on the path to financial ruin. It was your guy that ran up record deficits. It was your guy that rammed through tax cuts that had little or no stimulative value.

        <

        p>What we’re now experiencing is the small government, you, Carla Howell, and friends have been working for.

        <

        p>How does it feel?  

      • Increases the deficit in comparison to the Affordable Care Act that it seeks to abolish, and increases taxes for 90% of the population.  Got to hand it to the Republicans, this thing is a complete clusterfu** in every sense of the word.

      • The budget can never be balanced by spending cuts. We would have to cut $600B/year. They can barely get to $60B and that’s the easy stuff!

        <

        p>The Dems are equally dumb in hoping that tax hikes will do it.

        <

        p>Hopefully the spending cuts will get put on the back burner and the growth targets approaching 3%/year will become the centerpiece.

    2. This is nothing short of abolishing Medicare and Medicaid, with the Scott Brown giving his approval.

      <

      p>While you have detailed the health care impact, it’s also fiscally irresponsible, the Republican plan with Scott Brown’s applause actually increases the deficit over the next ten years.  Matt Yglesias posted some details via the CBO.

      <

      p>

      <

      p>To add insult to injury, taxes go up for 90% of the population.  (I’ll give you one guess who the 10% that get a tax break.)

      <

      p>

      <

      p>Seems like a winner.  

      <

      p>A winner for the Democratic Party in 2012.

      • The tax savings for the rich, and costs for the poor chart has great shock and awe value, but for relevance, the chart could be truncated to show only the Middle 20%, the Fourth 20% and the next 10%.  

        <

        p>That’s where the revenue has ever come from and will ever come from: the middle and upper middle class.  All discussion about tax raises or cut to the bottom 40% or top 10% is minor dollars and major politcal theater.

        <

        p>Meanwhile the Democratic response to deficit reduction.

        • The Affordable Care Act does a better job in reducing the deficit that the Republican plan.  This is fact.

          <

          p>Then the Republican plan goes on to abolishing Medicare and Medicaid, that’s just dumb, we need to live in reality.  This is the stuff that make Republicans looks like a joke and unbelievable to the moderates.  Why can Republicans have a real plan?  Why can’t they live in reality and make tough choices?  This is a cop out.  Bring on 2012, if this is what Republicans are shoveling.

        • Then why bother raising taxes on the bottom 20%? I mean, really, stop and take a good look — that group makes on average $13K per year, and Ryan’s plan raises their taxes by $1600?? Given, by your own admittance, that very little revenue comes from that group and we shouldn’t bother even looking, why raise taxes on them? Why take away an extra 12% from the people who need it most?

          <

          p>By dismissing the plight of real people like this, you encapsulate in two paragraphs why Republicans are viewed (rightfully so) as uncaring and only out to line the pockets of the rich.

          <

          p>Societies are judged by how they treat the least well off among them. Republicans deserve to be judged harshly.

    3. Representative Ryan Proposes Medicare Plan Under Which Seniors Would Pay Most of Their Income for Health Care

      <

      p>The GOP is so intellectually bankrupt that thinks Paul Ryan has a thought. Baker writes:

      Representative Ryan would replace the current Medicare program with a voucher for people who turn age 65 in 2022 and later. This voucher would be worth $8,000 in for someone turning age 65 in that year. It would rise in step with with the consumer price index and also as people age. (Health care expenses are higher for people age 75 than age 65.)

      <

      p>And the ever ethical Heritage Foundation, upon which Ryan based his rosy plan, depends on a prediction of 2.8% unemployment. (Yeah, and pigs fly too). The Heritage Foundation scrubbed its site of the unrealistic figure, but hey, this is internet age.

      <

      p>And vouchers won’t save money:

      Privatizing and voucherizing Medicare does nothing whatsoever to control costs. We’ve seen that from the sorry history of Medicare Advantage. I’m sure that the Republicans will claim savings – but those savings will come entirely from limiting the vouchers to below the rate of rise in health care costs; in effect, they will come from denying medical care to those who can’t afford to top up their premiums.

      This is the Norquist Shuffle. Health care costs are hoisted on to individuals who can’t afford it and rising health care costs are no longer a problem for government.

    4. Act:  The First

      <

      p>Excited elephant charges into room.

      <

      p>”The weasels tell me our pigs are hungry again! They want more to satisfy their hunger. We’ll have to slaughter three-quarters of the sheep.”

      <

      p>Ass looks up from document with approval ratings from polls.

      <

      p>”Wait, you gotta do this with finesse. Even the sheep can stampede if you push too hard, you don’t want that, do you? Let me come up with a plan to slaughter less sheep than what you propose and sell it as a victory of bi-partisanship.”

      <

      p>Act: The Second

      <

      p>The barn has elephants, asses and rows of baying sheep. Weasels are looking on and taking notes. The elephant proposes:

      <

      p>”Our sheep, dressed as wolves, have more grasslands to get. Without these grasslands you will all starve. We, the elephants, propose to slaughter all the sheep and turn the carcasses over to the pigs for processing to wolf food.”

      <

      p>The sheep gasp. they make fearful “baaaa” noises and some start to pick up their dropping to throw at the elephants. An ass stands up:

      <

      p>”We asses have a great resolution! The elephants are into the loco weed! We need slaughter only half of the sheep!”

      <

      p>The sheep calm down and let their droppings fall. A lone sheep asks:

      <

      p>”Why do we need conquer other grasslands? We don’t need to slaughter any sheep. Can’t we just trade for what we need? Shouldn’t we be thinking of the sheep that have to live outside the barn?”

      <

      p>Dogs are on this sheep before any other sheep can think this out.

      <

      p>Act: The Third.

      <

      p>The slaughter rule runs into trouble with the elephant’s proposal and the ass’s counter-proposal. After much blustering debate the elephant and the ass, arm-in-arm:

      <

      p>”We all know that the barn is too big to fail, so we worked hard and have come to a compromise that pleases all. Three-quarters of sheep will be transformed and be known as the ‘Barnyard Saviors’ and a feed sack adorned with the sheep’s number will hang from a rafter.”

      <

      p>The sheep baa approvingly as they go out to line up for the trucks:

      <

      p>”Wow, did we ever get a good deal!”

      <

      p>The sheep and the asses lick their lips over the promise of high grade feed the weasels made them.

      <

      p>finis

      <

      p>

    5. First – “As a relatively high-cost state, and with a major concentration of academic medical institutions that get extra Medicare reimbursements to allow them to teach the next generation of physicians, Massachusetts is more dependent”  This sounds an awful lot like the arguments that drug companies make about the cost of R&D affecting the high price of medication.  this has been declared bad and deceptive by BMG – so what’s the difference?

      <

      p>Next – many/MOST states do not pay for nursing home care with Medicaid.  We here go through the hustle of ‘spending down’ to qualify as a pauper, while secretly hiding what Howie likes to call ‘our sacred savings’, wink wink.  In other states, people buy nursing home coverage – here, the Medicaid scam is too deeply ingrained for the idea of paying for coverage to gain much traction.

      <

      p>Are these systems you WANT to perpetuate?

      • This sounds an awful lot like the arguments that drug companies make about the cost of R&D affecting the high price of medication.

        <

        p>I don’t see how the this is anything like the statement made in the diary.

        <

        p>

        here, the Medicaid scam is too deeply ingrained for the idea of paying for coverage to gain much traction.

        <

        p>For the record, nearly half of all nursing home coverage in this country is paid by Medicaid, with an additional 12%-13% paid by Medicare. Only a quarter of the overall spending on nursing homes in the United States is out-of-pocket. So Massachusetts is not particularly out-of-line here.

        <

        p>And if you’re so concerned about differing eligibility in the Medicaid program, then one good option would be to federalize the program, like Medicare, so that eligibility standards are uniform across the states. Somehow, though, I don’t think conservatives would be too keen on that idea.

      • You say that most states do not pay for nursing home care with Medicaid.  Do you have a link?  A source?  I believe that long term care and care for the disabled is the largest portion of Medicaid spending nationwide.  

        <

        p>Are you really going to cite Howie Carr to prove a fact?  

    6. At one time I thought the Republicans had given up on reversing the New Deal. Was I wrong about that!!! I would like to see the President start defending the legacy of the New Deal. If done right we can preserve Social Security. Health care won’t be solved until we adopt single pay. Rep. Ryan’s proposal will only put more cost on seniors.

      <

      p>Remember, Social Security is the best anti-poverty program ever enacted!  

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