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The Real Paul Ryan

His Medicaid cuts would hurt seniors and the disabled

Sep. 12, 2012
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While Republican vice presidential nominee Paul Ryan has claimed that his plans to voucherize Medicare wouldn’t affect current seniors, his plans to radically revamp and reduce Medicaid would have an immediate impact on the elderly.

According to the state Department of Health Services, about 36,000 elderly and 174,000 people with disabilities utilize Wisconsin’s Medicaid programs.

Ryan’s budget blueprint, which passed the U.S. House of Representatives earlier this year, would transform Medicaid into block grants that would be sent to the states. Ryan has said this would allow governors to have more “flexibility” in operating their health programs. But it could also allow them to move people off Medicaid by making the eligibility requirements more stringent, reduce benefits, further reduce reimbursement rates for health care providers or require Medicaid recipients to pay more for their health services.

The block grants would no longer respond to changes in the economic cycle, either. Currently, Medicaid funding increases during recessions, when more people are out of work and need publicly funded health care, and decreases when demand does.

But that’s not all that Ryan has in store for Medicaid.

Ryan’s budget also calls for cutting Medicaid by one-third in the coming decade—about $810 billion in that period—and by half in the following decade.

A.J. Nino Amato, executive director of the Coalition of Wisconsin Aging Groups (CWAG) and a former hospital executive, said Ryan’s Medicaid plan only seemed to work in a “Libertarian Disney World.”

“There’s no way that you can cut another $800 billion from Medicaid without taking it off the backs of children, people with disabilities and people in nursing homes by cutting benefits and/or reducing reimbursement rates, which are already so low that [many] doctors aren’t going to take Medicaid patients,” Amato said. “Then what do you do? Basically, they’re designing a backdoor death panel.”

Citizen Action of Wisconsin Executive Director Robert Kraig said the for-profit insurance industry—one of Ryan’s biggest campaign contributors—won’t step in and provide adequate, affordable coverage to seniors and those with disabilities.

“[Republicans are] creating a society which is much crueler and in which there is a lot less ability for people to live fulfilling, independent lives,” Kraig said. “Ideologically, they don’t want to admit there’s a public role to [providing health services for seniors and those with disabilities]. The market’s not going to do that.”


In-Home Support for Families

Medicaid pays for about a third of all long-term nursing home care nationwide. While Medicare picks up the costs of the first 100 days in a long-term care facility for rehabilitation, Medicaid pays for long-term nursing home care after a resident’s savings have run out.

“The idea that [Ryan’s plan] affects no one 55 or over is false,” Kraig said.

In addition, Medicaid also funds services that allow seniors and those with disabilities such as autism or Down syndrome to stay in their homes. For example, the Medicaid-funded Katie Beckett Program, which former President Bill Clinton referenced in his Democratic convention speech, helps middle-income families pay their sometimes-extraordinary medical bills and other expenses that result from caring for a child with cerebral palsy, seizure disorder or other complex disabilities.

Lisa Pugh, public policy coordinator for Disability Rights Wisconsin, said that block-granting Medicaid and reducing funding would put these services at risk and place more stress on consumers and their families.

“I am really concerned for the impacts on people with disabilities if this idea moves forward,” Pugh said. “I think it’s hard to say exactly what would happen, but I don’t know how less money, with less oversight of the expectations of who the programs should serve and what supports they should receive—I don’t know how we will continue to support the people who need it.”


Amato: ‘A Roadmap to Poverty’

CWAG’s Amato said that Ryan’s desire to slash the program has been supported by Gov. Scott Walker and DHS Secretary Dennis Smith. In 2011, Walker and Smith attempted to place a cap on Wisconsin’s Medicaid-funded Family Care program, which provides support for seniors and the disabled living at home. Their plan to cap enrollment was foiled only because the public—and U.S. Health Secretary Kathleen Sebelius—prevented it from happening. Later, Walker took credit for lifting the enrollment cap without admitting that Sebelius wouldn’t allow him to slash the program.

Amato said the ultimate result of Ryan’s Medicaid plans would be to reduce the independence of the most medically vulnerable individuals, who are unable to earn or save enough money for their health care, and place more stress on their families.

“This fits the [Republican] health care model of ‘individual responsibility’ and that health care should be market-driven,” Amato said. “If that happens, people will be taking in their parents. They’ll be taking in their kids. This is not a ‘roadmap to prosperity.’ This is a roadmap to poverty for seniors and anyone who is currently on Medicaid.”

A DHS spokeswoman did not respond to the Shepherd's request to comment for this article. 


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