This is Part 4 in a series. Find previous parts here .
The more I read about the projected impact of the Romney-Ryan budget proposal, and the more the GOP candidates talk about their plans for the economic future of this country and its people, the more anxious -- and angry -- I grow.
The topic for this fourth part of my series on the Romney-Ryan budget is Medicaid; but first, I can't emphasize enough: We now have overwhelming evidence demonstrating just how out-of-touch Republican presidential candidate Mitt Romney is with the hard-working and struggling people of this country. In a frank moment shared with deep-pocketed donors, Romney dismissed nearly half -- 47 percent -- of U.S. voters as beholden to Barack Obama because the president is financing their "dependent" lifestyle.
Romney doesn't seem to care if the government takes taxes out of every paycheck you earn; when you sit down to do your income taxes each year, if your wages are sufficiently modest that the bottom of your 1040 doesn't have a number in the "amount you owe" box, then you must be some kind of freeloader. Never mind the payroll, state, property, sales and other taxes you pay. Never mind that the right-wing is always arguing that folks should keep more of the money they earn. Never mind that conservatives have long said that taxes are bad. Now it's the low- and moderate-income people who don't pay enough taxes that are bad.
In Romney's world, and the world of his running mate Rep. Paul Ryan, a large group of people have supposedly decided they would rather be "victims" than "take personal responsibility and care for their lives." Romney's would-be spongers include teachers, child care workers, waitresses, home health care workers, grocery store cashiers, social workers, police officers, firefighters and many others who, as Nicholas Kristof said, "have contributed far more meaningfully to America than some who can shell out $50,000 to attend a fund-raiser like the one where Romney spoke in May."
In the estimation of the Romney-Ryan campaign and the radical fringe who have taken control of the Republican Party, this country is afflicted with millions of lazy people who want to sponge off the hard work of the righteous. They are not underpaid and underemployed people doing the best they can to care for themselves and their families, in need of a hand up before they sink down even further. Nope -- they are selfish moochers.
And in case you need to be reminded who the most selfish of all moochers are, well Romney is only too happy to tell you. One of his ads that ran in heavy rotation this summer stated: "Under Obama's plan, you wouldn't have to work and wouldn't have to train for a job. They just send you a welfare check. And welfare-to-work goes back to being plain old welfare." That's right -- low-income moms, disproportionately women of color, are the villains in this decades-old, deceitful and divisive ploy to win party allegiance and votes.
It's this kind of thinking that allows Romney and Ryan to initiate such a reckless attack on Medicaid. If the people you're hurting with your policies are blameworthy -- irresponsible loafers and swindlers who think they're entitled to health care, food, housing, you name it -- then it's ok to punish them, right?
But the world is not the simplistic, producers-and-moochers fantasy promoted by Ryan's hero, author Ayn Rand. (It's worth noting that most people outgrow their black-and-white worldview not long after middle school; Paul Ryan's continuing devotion to it tells us just how shallow his economic thinking is.) The real world is complex and gray, and the people who would suffer under the Romney-Ryan budget are living, breathing human beings, not caricatured cardboard cut-outs.
Before we assess what would happen to Medicaid under Romney-Ryan, let's look at how it works right now. Medicaid is a health care program for the most vulnerable among us, jointly funded by the federal government and the states, with no middle guy/insurance company to add an extra layer of costs. Each state administers its own program, so no two states have exactly the same plan. This means there is a fair amount of flexibility from state to state as to who is eligible for benefits. But federal law does determine a minimum level of coverage that must be met, constructing a floor under which the states must not drop.
And just who does Medicaid serve? It shouldn't surprise you to learn that it's mostly women and children. The National Women's Law Center recently reported that the poverty rate for women is now 14.6 percent, compared with 10.9 percent for men. In other words, more than one in seven women live in poverty in the U.S., and, shamefully, an astounding one in four women of color live in poverty. Today, some 50 million of these women and their children get health care through Medicaid. By 2014, thanks to Obamacare, as many as 10 million more will become eligible, too.
More than half of all poor children in this country live in households headed by women. Medicaid means that millions of low-income moms don't have to choose between a doctor's appointment for a child versus food for the family. And it provides essential prenatal and postpartum care for pregnant women. Astonishing as it might sound, Medicaid covers almost half of all childbirths in the U.S. -- resulting in healthier mothers and healthier babies.
In middle-class families, many children with acute illness or disabilities receive desperately needed health care through Medicaid. Our allies at MomsRising have collected countless stories from women who have been in this position.
Here's Jennifer's story:
When my daughter was diagnosed with a malignant brain tumor at 15 months of age, I had to quit my job to take care of her while she received chemotherapy and IV meds literally around the clock as an inpatient. Due to the loss of my income our family could no longer afford to pay for insurance for all of us so we applied to Medicaid for my daughter. Medicaid saved us financially, and covered LIFE SAVING chemotherapy medication that our insurance would not have covered anyway. My daughter is now over 4 years old and thriving.
Sounds like a real deadbeat, huh?
Women with disabilities also rely on Medicaid to help pay for their own health care. According to the Kaiser Family Foundation, half of women under 65 with permanent mental or physical disabilities have Medicaid coverage.
In their retirement years, women's health care expenses go up more than men's, but after a lifetime of unequal pay, they have less savings, less Social Security and less retirement income to cover their needs. For them, Medicaid often picks up where Medicare leaves off. Remember our retired friend Linda and her daughter Emily? Linda relies on her state's Medicaid program to help pay the balance of her doctors' bills and prescriptions, and she is greatly relieved to know that Emily doesn't have to deplete her own savings to help with these costs.
One day, if Linda needs more care than her daughter can provide, Medicaid will help pay for her to stay in a nursing facility. A long-term care facility is not cheap -- most people in this country could not afford such care on their own, nor could their family members afford to foot the bill without quickly compromising their own financial stability. Because of this virtually inescapable reality, roughly half of all Medicaid dollars go toward nursing homes. But don't worry. Mitt Romney and Paul Ryan are going to put these layabouts in their place.
The Romney-Ryan budget plan "block grants" Medicaid, meaning the federal government would send a set amount to the states each year, after which they're on their own. There would be no more minimum requirements for coverage, no floor below which the states cannot descend. It wouldn't matter how sick eligible people become, or how much they need home health care or nursing home care. Because for Romney and Ryan, it's not about health, it's about the money. According to a Congressional Budget Office (CBO) analysis "federal spending for Medicaid would be 35 percent lower in 2022 and 49 percent lower in 2030 than currently projected federal spending." That's how they measure success.
With less money coming from the federal government, states would either make up the difference themselves, which seems highly unlikely considering how hard-hit the states have been in this economic downturn, or drastically cut benefits, the most likely outcome. Under the block grant scheme, "between 14 million and 27 million fewer people would be covered in 2021 than under Medicaid as it currently exists," according to an analysis by the Urban Institute.
Additionally, Romney-Ryan would repeal Obamacare, including its expansion of Medicaid to cover people making less than 133 percent of the federal poverty level. As estimated by the CBO, this would push an additional 11 million people back into the ranks of those without access to health coverage.
What do Romney and Ryan think all these people are going to do? Do they really think that millions of people just need a swift kick to get them raking in the bucks? That denying health care to poor women will magically make them find better-paying jobs, build up hefty savings accounts after years of working at minimum wage, or prevent their children from developing disabilities? How many more people would have to fall into poverty and die too soon before this ridiculous experiment would be considered an utter failure?
I think that if Mitt Romney and Paul Ryan were to answer those questions honestly -- despite their reputations as Governor Etch-a-Sketch and Lyin' Paul Ryan -- they would admit that their agenda is pretty simple: reward their fat cat supporters with more advantages, riches and privilege; punish anyone who didn't get the opportunities or breaks in life that they did; and turn to Ayn Rand's shaming and blaming rhetoric as justification for it all. Sounds like the real moochers in this scenario are the ones looting Medicaid.
How much worse could the Romney-Ryan budget plan get? Stay tuned...
Follow Terry O'Neill on Twitter: www.twitter.com/Terryoneill