Griswold v. Connecticut

The Affordable Care Act will expand eligibility for Medicaid, beginning January 1, 2014, to cover all Americans with family incomes up to 133 percent of the federal poverty guidelines ($29,326.50 for a family of four in 2010). This expansion is one of the three primary mechanisms for covering additional uninsured Americans, along with reliance on the current employer-sponsored insurance system, and creation of Insurance Exchanges. States will have the primary responsibility to implement the Medicaid expansion, complying with new federal requirements, many of which will be clarified in forth-coming regulations. Below is list of Medicaid issues legislators may want to consider before the expansion of Medicaid in 2014. – National Conference of State Legislatures

Republicans feel it’s 2012 or bust, because the drop dead date for austerity is 2014.

Politico runs an important story today wondering why Democrats aren’t talking about Medicaid, in addition to Medicare, driving home the point of Republican austerity, which puts the most vulnerable in jeopardy.

Medicaid “doesn’t quite have the same political dynamic” as Medicare, (New Jersey’s Rep. Robert) Andrews said.

Yeah, the poor go quietly, but AARP members will not.

According to reports, Barack Obama won 73% of the vote of people making under $15,000. Republicans don’t have a vested interested in these voters, because they vote less frequently than Medicare recipients and are unlikely to vote GOP for a reason. Maybe that’s why Paul Ryan’s budget, which has been reported before, plans to cut roughly $1.4 trillion from the poor’s safety net.

Also in Ryan’s sights is the Affordability Care Act, which Republicans want to eliminate completely, but if they can’t do that, cutting Medicaid by $770 million would be another way to get the job done, simply by turning Medicaid into state block grants. From early April in the American Prospect:

There are several ways states can pass on the Medicaid savings: reduce eligibility to trim the Medicaid rolls, cut recipients’ benefits, and reduce provider payments. Presumably all three would occur, and the balance between them would vary by state.

But not all Medicaid beneficiaries require the same amount of spending, and those who cost the most would most likely see their benefits limited or cut. Older people and people with disabilities make up the majority of Medicaid expenditures but are only about a quarter of Medicaid recipients. They are much more likely than the general population to depend on expensive long-term care and ancillary services like mental health, home-health aides, and occupational or physical therapy. Right now, if a state chooses to cover those needs, the federal government kicks in a significant portion of the cost, but that would change under Ryan’s block-grant plan. States would have a financial incentive to cut the most vulnerable because they are the most expensive. “Medicaid is already a pretty lean program, so block grants create a big incentive for states to cut back on things that vulnerable people really need,” says Harold Pollack, a professor of social policy at the University of Chicago.

Proving that policies are fought in the mainstream and where the most likely voters can be reached, there’s not been any attention whatsoever to what the Republican budget would do to Medicaid. From Politico:

Yet, for all the Democrats’ posturing and campaigning against Republican plans for Medicare, the GOP budget actually makes more immediate and deeper cuts to Medicaid. But Democrats haven’t been blasting the GOP Medicaid plan with nearly the same fervor, even though Republicans would cut about $750 billion from the program during the next decade and end the guaranteed federal match for states.

[...] Medicaid covers more than 50 million people, including low-income children and seniors in long-term care, but it doesn’t pack the same political punch as Medicare. Some observers say that’s due to the lingering perception that Medicaid is just a program for poor people that holds a much less broad-based appeal.

It’s also about kids. ACA pumped up the “Medicaid for kids” program, which Ryan and the Republicans are targeting.

Maybe the reason they’re getting away with it without a peep from Democrats is because Pres. Obama tried his own version earlier this year with cutting home heating assistance for the poor.

It’s not the two America’s syndrome, it’s that we have separate and unequal economic realities, with Democrats not doing anything to make the case for helping the poor.

Ironic that the only guy who ever made that case is now fighting to stay out of jail in an FEC case that’s never been brought before in U.S. history; while Wall Street bankers who broke our financial system and trumpet Republican tax policies as the answer walk around free from guilt or reprisal.

There is no conversation coming from Democrats or Pres. Obama about what the GOP wants to do with Medicaid if given the chance, even as Republicans push austerity through Medicare, because in the age of Obama it seems the party of Robert F. Kennedy doesn’t do that anymore.

Don’t get me wrong, it’s not that Pres. Obama and his administration don’t care about the poor, which ACA proved in writing and spirit, even if there’s been no defense of the specifics since Rep. Ryan’s budget landed. It’s just that Obama has no intention of putting the power of the presidential bully pulpit behind a strong offense over something that would not bring out voters that don’t normally vote for him anyway.

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