Medicaid – Page 2 – charles' log

From: workingamerica blog

By: Seth D. Michaels

N.B.: A concise, lucid explanation of what they say, what they mean, and what we need.

“It took approximately five minutes after the announcement of Paul Ryan as the Republican running mate for the spin to begin. Anxious to pre-empt a conversation about Ryan’s plan to end the guarantee of Medicare, the Mitt Romney campaign ison the air with some (strikingly dishonest) Medicare ads of their own. They have plenty of money to advance this message, so it’s worth unpacking what’s really going on.

First and foremost, the Ryan plan, in any form, would mark the end of Medicare as we know it—as a guarantee of health coverage for senior citizens. Instead, it would give older people a voucher to go buy their own private insurance. The Ryan budget would also increase the eligibility age, delaying the time when retirees could get Medicare. That’s the proposal the U.S. House voted on and passed in March and it’s the model Ryan has continued to promote even as he’s suggested possible tweaks.

So let’s move on to the claims the Romney campaign is making. The Affordable Care Act is paid for partly through billions in future savings—about $700 billion over 10 years in reduced payments to health insurance companies and providers. A lot of that money stays in the Medicare system, by paying for free preventative care for seniors and closing the prescription drug “doughnut hole.” The attack leveled by Romney, Ryan and their allies—an attack that’s Jonathan Cohn rightly called “astoundingly cynical”—is that this constitutes a massive cut to Medicare.

But here’s the catch: in the Ryan budget that passed, these future savings are included, even as the rest of the ACA is repealed. So the same reductions that the Romney campaign is complaining about were voted on and approved by Ryan and virtually every House Republican.

In the ACA, the cost savings that come out of Medicare go back into the health care system. In the Ryan budget, they’ll be needed to pay for the massive tax cuts proposed in that plan. Cohn notes that not only does this money get pulled out of providing health care entirely, but the attack the Romney campaign is making is a “brazen misrepresentation of reality.” Or, to say it in fewer and shorter words, “a lie.”

The Ryan plan doesn’t replace the guarantee with the vouchers for 10 years, so that major change doesn’t immediately affect today’s retirees. But the repeal of the ACA’s provisions on prescription drugs and preventative care absolutely will. If those provisions are gone, seniors who are on Medicare now will be paying hundreds of dollars more out of pocket. Ryan’s cuts to Medicaid, which many seniors depend on for nursing home care, would also have a big impact—his proposed cuts to Medicaid and the repeal of the ACA Medicaid expansion are a big and under-covered change in his budget. Some 6 million of today’s retirees depend on Medicaid and could lose out under Ryan’s plan. This is what was in the Ryan budget the House passed, and he hasn’t backed off of this at all.

What’s more, if Ryan’s plan kicks in ten years from now, today’s Medicare beneficiaries will getan unpleasant wake-up call as the voucher plan starts to erode the program:

In 2022, when the limited-subsidy program would be introduced, seniors who qualified for traditional Medicare would be allowed to switch to the new program. If healthier or younger beneficiaries make the change to lower their out-of-pocket costs, those still participating in Medicare would be part of an insurance pool that is less healthy and more expensive. To cover those higher per-person costs, Medicare might well be forced to either raise premiums or limit reimbursements to health care providers—which could prompt many to stop taking Medicare patients.

Romney has suggested he may back off of the Medicare savings that Ryan included in his original budget. But in that case, the Ryan budget math gets even more implausible. And by the standards Romney has laid out for how he wants his budget to work, Medicare would have to be slashed either way. That these cuts to programs for vulnerable people would be required in order to pass his huge tax cuts for the rich adds insult to injury. As Derek Thompson notes, Romney’s proposals “have clear and inevitable conclusions: Tax cuts for the richest and spending cuts for the poorest.”

It’s hard to overstate how hypocritical and dishonest the new Romney-Ryan attacks over Medicare are, coming from two people who have pledged changes so radical that they’d leave it unrecognizable.

Emphasis Mine

see::http://blog.workingamerica.org/2012/08/15/the-facts-behind-romney-and-ryan%E2%80%99s-medicare-lies/

By Robert Creamer, HuffPost

“Last Thursday’s Washington Post headline blared: “Debt panel’s lack of progress raises alarm on Hill.”

In fact it is far better for everyday Americans if the so-called Super Committee fails entirely to get a deal.

The overarching reason is simple: any deal they are likely to strike will make life worse for everyday Americans — and worsen our prospects for long-term economic growth.

Of course that’s not the view of many denizens of the Capitol who are still obsessed by the notion that it is critical for the Congress to produce a “compromise” that raises revenue and cuts “entitlements.” There are three reasons why these people are wrong:

1). Any deal would likely slash the income of many everyday Americans. You could design a plan to substantially reduce the deficit without big cuts in Social Security, Medicare or Medicaid. My wife, Congresswoman Jan Schakowsky, who served on President Obama’s Fiscal Commission, designed just such a proposal last year. And, of course, Social Security has nothing to do with the deficit in the first place.

Unfortunately, however, in order to get Republican support any large-scale deal in the Super Committee would almost certainly require big cuts in either Social Security, Medicare or Medicaid — or all of them. Substantial cuts in any of these programs will make life harder for everyday Americans and reduce the likelihood of long-term economic growth.

Without a “deal” in the Super Committee, the current budget plan does not cut Social Security, Medicare and Medicaid — and that’s a good thing.

According to the Social Security Administration, the average monthly Social Security check now averages the princely sum of $1,082 — or about $13,000 per year. Next year, for the first time since 2009, payments will increase by $39 per month to offset inflation, but $18 a month of that increase will go right back out the door in the form of Medicare premium increases.

Already under current law, Medicare Part B premiums, that cover services like doctors, outpatient care and home health services, must be set annually to cover 25% of program costs. And remember that Medicare recipients aren’t getting an “entitlement” — they are getting an earned benefit that they paid for throughout their working lives. The same, of course, is true of Social Security.

Mean while, Medicaid is the principle means of assuring that America actually begins to provide health care for all — including nursing home and home care.

The problem with medical care costs isn’t that “greedy” seniors and others are gobbling up too much care. The problem is that the costs of providing care are going up too fast. In fact, the per capita costs of providing health care in America is 50% higher than anywhere else on earth, and the World Health Organization only ranks health care outcomes as 37th, in the world.

Medicare is actually the most efficient means in the American economy for providing health care. Any action by the “Super Committee” that reduces the percentage of Americans on Medicare — say, by raising the eligibility age from 65 to 67 — would cost the American economy.

According to a study by the Kaiser Family Foundation, if such a proposal were operational in 2014 it would raise total health care spending in America by $5.7 billion per year.
This is so because, while it would save the Federal government a net of about $5.7 billion ($24 billion savings in Medicare payments largely offset by $18 billion of increased Medicaid payments and subsidies to low-income participants in exchanges), it would also generate an additional $11.4 billion in higher health care costs for individuals, employers and states — resulting in a net cost to the economy of $5.7 billion.

The one thing you could do to cut Medicare costs without hurting ordinary families or the economy as a whole is to require Medicare to negotiate with the drug companies for lower prices the same way the Veterans Administration does today. That would cut hundreds of billions in costs to the government over the next ten years, but don’t expect the Republicans to include that as an acceptable cut in “entitlements” as part of a Super Committee deal.

Of course, America has no business cutting the income of seniors who get $13,000 a year in Social Security payments regardless of anything else that is in a deal. The deficit problem should be fixed by asking millionaires and billionaires to pay their fair share and by jobs plans that put America back on a path of sustained economic growth. And we have no business reducing access to health care for everyday people so that CEO‘s can fly around in their corporate jets, oil companies can keep their tax breaks, or Wall Street hot shots — who we all bailed out just three years ago — can pack in their huge bonuses.

Even if a Super Committee proposal includes increases in revenue to the government from millionaires and billionaires, that is not reason that normal people — whose real incomes have dropped over the last decade — should also be called upon to “share in the sacrifice.”

The problem isn’t that everyday Americans are gorging themselves on excesses that “America can’t afford.” The problem is that Wall Street, the financial sector and the 1% have gobbled up all of the increases in economic growth that the country has produced over the last two decades.

That has meant that the standard of living for normal people has been stagnant. But just as problematic, it has lead to a stagnant economic growth. Since the incomes of everyday people haven’t increased at the same rate as increased worker productivity, there simply haven’t been enough new customers to buy the new products and services that American businesses produce. That is the formula for recession and depression. And that’s just what happened.

American corporations are sitting on two trillion dollars of cash. The reason they aren’t hiring has nothing to do with the need for more tax breaks. What stops them isn’t lack of “confidence,” it’s a lack of customers.

For decades the International Monetary Fund (IMF) has preached the need for fiscal constraint and austerity. According to the Washington Post, now even the IMF is warning that, “austerity may trigger a new recession, and is urging countries to look for ways to boost growth.”

If you want to lay a foundation for long-term economic growth in America, the last thing you would do is reduce the income going to ordinary Americans — even over the long run. That’s not the problem — just the opposite. We do not need ordinary people to “share in the sacrifice.” We need policies that will increase the share of income going to ordinary people and reduce the exploding inequality between the 99% and the 1%.

Any deal in the Super Committee will almost certainly do just the opposite.

2.). The worst effects of sequestration could be solved without a “grand bargain”. The one big downside of a failure of the Super-Committee to act would be the level of discretionary spending cuts that would be required through the resulting sequestration. This is particularly true of cuts in education funding.

The budget deal that was struck in order to prevent Republicans from plunging America into default last summer requires an additional $1.2 trillion reduction in the deficit over the next ten years. If the Super Committee fails to agree on the distribution of these cuts, they will automatically be spread over defense and non-defense segments of the budget beginning in 2013. But there would be no cuts in Social Security, Medicare or Medicaid.

Congress would have the ability to adjust these sequestration requirements between now and 2013, regardless. But the “fast track” authority that would require up or down votes on a proposal from the “Super Committee” would expire if the Committee cannot reach agreement by November 23rd.

The best solution to the problem of big cuts in discretionary spending would be to put together a smaller deal to raise some revenue and reduce cuts in discretionary and – if necessary — military spending — after the mandate of the Super Committee has expired.

The Congress will have a year to help solve this problem, and the pressure to ameliorate some of the cuts in military spending that have so far proved ineffective at forcing Republicans to consider big revenue increase, may be more persuasive when it comes to smaller increases as the actual date of sequestration (2013) draws near.

Of course it’s possible that the Super Committee itself could come with a small-bore deal of this sort, simply to avoid the full force of sequestration. But that would be very different than a $1.2 trillion dollar package that includes cuts in Social Security, Medicare and Medicaid. Progressives should avoid cuts to these programs at all costs, because any cuts that sliced Social Security, Medicare or Medicaid benefits would require changes in the structure of the programs themselves that would last forever. Cuts in discretionary spending — as bad as they might be — are one-time events and do not fundamentally change the structure of the American social contract.

3). There is no reason for Congress to fear that its failure to act on a “Super Committee” agreement will have massive adverse consequences on “market confidence,” since the level of the deficit will not be affected. That has already been set — with a mandate for a $1.2 trillion cut. The Wall Street gang and the ratings agencies might sputter something about government dysfunction for a day or two. But the fundamentals will not be affected, since the level of government borrowing won’t be affected by whether or not there is a deal.

It’s also worth noting that even after Standard and Poor’s downgraded the U.S. debt because of the process leading up to the debt ceiling deal, it had no effect on the interest rates the government is paying for bonds. In fact those interest rates dropped to record lows. U.S. government debt remains the safest investment in the world, no matter what S&P did, and the market reflected that indisputable fact.

In other words then, Congress does not have its back against the wall like it did during the debt ceiling “hostage” crisis. When it came to the debt-ceiling deadline, failure was not an option. In the case of the “Super Committee” failure to come to an agreement is a very real option — in fact, it’s the best option.

There are some in Congress — most notably in the Senate — who truly believe that what the country needs is a “grand bargain” that cuts the deficit by making ordinary people “share in the sacrifice” even if millionaires and billionaires are asked to share some as well.

Hopefully those who are working for such bargain will be thwarted by two important political realities.

First, that cuts in Social Security, Medicare and Medicaid are politically toxic. People get really angry when you take away something they have earned.

Second, the Republican’s stubborn unwillingness to give an ounce of new revenue from the pockets of millionaires and billionaires – who, after all, are the true core constituency of the Republican Party.

This time a little “gridlock” may be a good thing.”

Robert Creamer is a long-time political organizer and strategist, and author of the book: Stand Up Straight: How Progressives Can Win, available on Amazon.com. He is a partner in Democracy Partners and Senior Strategist for Americans United for Change. Follow him on Twitter @rbcreamer.

Emphasis Mine

see: /robert-creamer/three-reasons-why-its-bet_b_1030166.html

Tag: Medicaid

The Facts Behind Romney and Ryan’s Medicare Lies