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Medicare and Social Security have been getting the bulk of the attention from outside advocacy groups, the punditry, and actual fiscal cliff curb negotiators in the past few weeks. Medicaid has been left largely out of the mix, and that's potentially a problem. Because it doesn't have the same public advocacy profile, it could become a big, juicy target for budget cutters. Delaware Gov. Jack Markell, chairman of the National Governors Association, is one advocate for Medicaid. He made his case directly to President Obama this week.
Markell said reductions in federal funding for Medicaid could force Delaware to consider abandoning its decision to expand the low-income health care program as envisioned under Obama's 2010 health care law. An additional 20,000 to 30,000 Delawareans are expected to be covered by the Medicaid expansion, which is scheduled to take effect in 2014. Medicaid accounts for an over-sized portion of Delaware's $3.5 billion budget and is projected to cost the state $780 million in the upcoming budget year.

"Some of us have made the decision to expand Medicaid," said Markell, who serves as the National Governors Association chairman. "In our case, we made that decision because of the underlying economics, the fact that there is a higher reimbursement for the population that we're already serving. Clearly if that were changed, we would have to revisit that decision."

Markell raises a key point: Medicaid expansion is foundational to the Affordable Care Act and without it, millions could still be left out of Obamacare's reforms. It's not just those being left out that pose a problem for the reforms and for health care costs in general going forward. Medicaid is extremely cost effective to run, with the CBO estimating that it costs about 50 percent less to insure people through Medicaid than to subsidize private insurance from a state-run health insurance exchange. Providing expanded Medicaid coverage will help drive down costs through the entire health care system, a systemic view that lawmakers generally overlook when looking at the government's bottom line.

Because Medicaid is so efficient to run, there's not a lot of cost savings to be wrung out of it, Sara Rosenbuam, a professor of health law and policy at the George Washington University School of Public Health and Health Services, argues. She writes that the kinds of cuts being discussed in Washington would be "shaking its structure in ways that reduce basic coverage." Reducing basic coverage would exacerbate the crisis that the Affordable Care Act was passed to start solving.

The Medicaid expansion is already under assail thanks to the Supreme Court ruling that states could opt out. Further undercutting this linch-pin to Obamacare in the fiscal cliff fight would be cutting reform off at its knees. Health care costs are most definitely a driving force for the deficit, but austerity is most definitely not the answer to creating long-term savings.

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Comment Preferences

  •  With Mom Months From Going Bust in Assisted Care (8+ / 0-)

    but having a pension, we're terrified that her pending medicaid might be cut or canceled.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Fri Dec 07, 2012 at 07:35:34 PM PST

  •  How about true single payer (6+ / 0-)

    and be done with this. We couldn't dream up a more complex system than what we have now. Medicare for all - done.

  •  It's about time someone noticed this. (6+ / 0-)

    I've been squawking about this for months now.

    Everyone in DC seems to be pointing to Medicaid as the one program people are willing to slash in these budget deals, but they seem to have forgotten that it's supposed to take care of MILLIONS more people when the ACA kicks in. If they cut the program before 2014, we will never see any coverage.

    And I'm sure that's the plan.

    "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

    by Brooke In Seattle on Fri Dec 07, 2012 at 07:40:55 PM PST

  •  This decision should not be up to politicians (3+ / 0-)
    Recommended by:
    J M F, sceptical observer, Egalitare

    American voters should get an opportunity to decide  whether we'd prefer to chip in a few dollars more every month (yes, we know that the cost of health care had gone up) to make sure poor children and the disabled can access health care, or whether we'd just prefer to let poor children and the disabled waste away and die on the streets, their bodies to be collected by roving hearses.

    Oh, wait! We did get to vote on that, and we re-elected Barack Obama and Joe Biden, not Mitt Romney and Paul Ryan. That should settle it.

    “Social Security has nothing to do with balancing a budget or erasing or lowering the deficit.” -- Ronald Reagan, 1984 debate with Walter Mondale

    by RJDixon74135 on Fri Dec 07, 2012 at 07:45:29 PM PST

    •  Medicaid is the Safety Net for Middle Classers (5+ / 0-)

      who join the poor for the first time in their lives on health care, especially seniors who need nursing care.

      IT's that or send them home for their 50-something kids to change their diapers.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Fri Dec 07, 2012 at 07:54:29 PM PST

      [ Parent ]

      •  Very true, Gooserock, and many 60 somethings (1+ / 0-)
        Recommended by:
        Egalitare

        are going to have some hard realities to face when they learn that Medicare doesn't pay anything for Alzheimer's inpatient care for their 80 something parents. The Alzheimer's Assn tells us that our chance of having Alzheimer's by the time we're 85 years old is almost 50-50.

        “Social Security has nothing to do with balancing a budget or erasing or lowering the deficit.” -- Ronald Reagan, 1984 debate with Walter Mondale

        by RJDixon74135 on Fri Dec 07, 2012 at 08:38:17 PM PST

        [ Parent ]

  •  So we're a society... (2+ / 0-)
    Recommended by:
    sceptical observer, J M F

    ...how about not balancing the books on the backs of those who are least able to fund attack ads? Like the disabled and the poor? Is that controversial? No? Well, progressives made anti-gay nonsense toxic, why not anti-poor nonsense too? I'm a believer, now. We can stand up to this stuff, and we can win. There's no reason why the economic well-being of our country has to rest on the economic hopelessness of others.

    it fitfully blows, half conceals, half discloses

    by Addison on Fri Dec 07, 2012 at 07:52:53 PM PST

  •  In addition to everything else (0+ / 0-)

    a little upfront care will help keep a lot of people out the ER. They can pay now or pay even more later.

    "The human eye is a wonderful device. With a little effort, it can fail to see even the most glaring injustice." Richard K. Morgan

    by sceptical observer on Fri Dec 07, 2012 at 08:04:03 PM PST

  •  They need Their trophy (1+ / 0-)
    Recommended by:
    Egalitare

    The job is to make it as symbolic as possible. At the same time we need to expand the political support for Medicaid.

    I suggest buy-ins for both Medicaid and Medicare. Start with Medicare and 55 plus buy-in in exchange for the 67 raise and then allow a Medicaid buy-in to offset the savings.

    •  It is very much a "Herd Animal Hunt" (0+ / 0-)

      Social Justice is a counterproductive objective from the perspective of the Financial Elites. It undercuts their justifications for hoarding wealth and assets for their own desires.

      Most of them think they have "evolved" beyond the aspirations of Elites in times past who wanted to leave a lasting legacy, be it libraries, schools, foundations, museums or any other entity that would live long after they "cash out." Now it seems being able to boast of causing the most premature deaths and unnecessary strife among "the losers" is the new marker of "success."

      When you are right you cannot be too radical; when you are wrong, you cannot be too conservative. --Martin Luther King Jr.

      by Egalitare on Sat Dec 08, 2012 at 02:26:46 AM PST

      [ Parent ]

  •  Back to the Narrative (0+ / 0-)

    This is all true. But the response needs to be not, "We need to save Medicaid, too," but, "We need to increase income for the poor."

    There are two reasons we have Medicaid. The fundamental reasons we have it are (1) because workers are underpaid and (2) because we have a for-profit healthcare system. Those two bad ideas come together to create the need for Medicaid.

    And the need won't go away just because Washington cuts funding. The need will be there because we underpay workers and because we pay too much for healthcare. We are paying workers a minimum wage of $7.25/hour when the living wage is generally higher throughout the U.S. and in many cases significantly higher. (As I quoted before, it's around $24/hour in New York. It's also around $28/hour in San Francisco. Let that sink in a minute.) And, we are paying over 17% of GDP for our healthcare system, while sensible countries pay about 10-12%.

    So, we need to tell these people that the trade off isn't higher tax rates for rich people. The trade off for cutting Medicaid needs to be a raise in the minimum wage and a long extension of unemployment benefits. I'm talking about an extension beyond 99 weeks.

    That's what will send the right message to these people. Whine, whine, whine about how much these programs cost. Whine, whine, whine. Well, okay. You want fewer people on these programs? You want to cut the costs.

    Then pay the f***ing people what they're worth!

  •  Seniors on Medicaid (1+ / 0-)
    Recommended by:
    cstark

    Nearly half of Medicaid goes toward health care for senior citizens, quite a bit of that for seniors in nursing homes. At well over $225/day, not many seniors with any savings will have enough $$ to pay their way for very long. As if is now, Medicaid payments to nursing homes usually underpays compared to expenses, so nursing homes have a difficult time providing services AND paying decent wages.We need to keep this issue before the congress.

  •  We have to stand our ground. (0+ / 0-)

    We do not have a Medicare Problem...

    We have a Healthcare cost problem....

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