“My View” from the Aug. 17, 2012, edition of “Viewpoint with Eliot Spitzer.”
The hot election issue in this country right now: Medicare — who is doing what to it and why. According to the most recent Kaiser Health Tracking Poll, 73 percent of American adults think Medicare is either extremely or very important, ranking it highest among health care issues.
But there’s another issue out there that we should be talking about just as much, if not more: Medicaid.
Because unlike the Medicare reforms in Paul Ryan’s budget, which kick in years from now, the assault on Medicaid starts immediately — and could have devastating effects.
Ryan’s budget, starting in 2013 — yup, that’s right, next year through 2022 — would cut $1.4 trillion from Medicaid, the government’s health insurance program that primarily serves low-income individuals. It would block-grant the dollars to the states, consequently leading to — as measured by the nonpartisan, universally respected Congressional Budget Office — a minimum of 14 million people being dropped from the program. This doesn’t include the 11 million people who would be dropped from Medicaid if the Romney-Ryan plan to repeal health care reform is implemented.
Folks who would be dropped from Medicaid are almost inevitably going to be incapable of getting private insurance, so the vast majority would go without health insurance at all. Without health insurance, they will get vastly inferior health care, usually with little preventive care. So the choice between the president’s program, which will lead to about 17 million gaining coverage, and the Ryan plan, which would lead to about 25 million losing coverage, could not be more stark.
But play this scenario out a bit more. What will happen when these 25 million lower-income Americans need care?
Sure, some of it will be paid through out-of-pocket payments, but an awful lot will be deemed charity care by providers, and that cost will be picked up by everybody else — through higher premiums in private insurance, tax payments to state governments that are then used for charity care payments to the hospitals or direct charity.
All of which explains why the president both expanded Medicaid and created the individual mandate. That way there would be logic to both how we provide health care and how we pay for it.
It may not be fashionable these days to spend much time talking about how we ensure that the social safety net doesn’t get torn in too many places, but the Ryan budget tears an enormous gaping hole in the very center of that net.
It’s good that we are talking about the Medicare issues in the campaign — let’s spend a few minutes talking about Medicaid as well.
That’s “My View.”