09/07/2012 12:11 pm ET Updated Nov 07, 2012

Where Are the Candidates on Medicaid?

Since the selection of Congressman Paul Ryan (R-WI) as the 2012 Vice Presidential candidate for the Republican Party, there has been an increasing focus on how each party would tackle health care reform under their Administration. Maybe this is because prior to being tapped as the GOP VP candidate, Ryan served as the House Budget Committee Chairman and in that capacity proposed drastic cuts to entitlement programs including Medicare and Medicaid. Or perhaps it is because the Supreme Court recently upheld most of the key elements of the Affordable Care Act (ACA). Quite possibly, it could be because in 2006, Governor Romney signed a health care reform law in Massachusetts that many cite as the blueprint for the ACA. Whatever the case may be, it's apparent that there is clear and growing interest in where the candidates stand on health care.

For the most part, the coverage has been focused on the candidates' positions on Medicare, which is not surprising knowing that both parties want to appeal to the elderly, who are known to be the most consistent voting demographic. However, little to no attention has been given to the candidates' positions on Medicaid, even though the elderly who may reside in nursing homes, or otherwise need long-term health care account for a significant portion of Medicaid expenditures. More importantly, children, who make up over half of the Medicaid beneficiaries, but effectively no voting power, and the remaining beneficiaries (the poor and disabled) tend to be among those least likely to be engaged in the election process. The outcome of the November elections will significantly impact the future of the Medicaid program and the coverage provided to current and prospective beneficiaries and therefore it's important to understand where the candidates stand on this critical safety net program.

The passage of the ACA in 2010 and the Children's Health Insurance Reauthorization the year prior provided President Obama the opportunity to make a defining statement about his vision for providing health care coverage to poor children and their families as well as other vulnerable populations, the disabled and the elderly, that tend to be Medicaid beneficiaries. Under these reforms Medicaid coverage has been expanded, strengthened, and protected for the future years. Additionally, under ACA and CHIP the number of uninsured has decreased and former foster youth are now eligible for Medicaid coverage until the age of 26. In his most recent budget proposal, President Obama highlighted his Administration's opposition to House Republican efforts to turn Medicaid into a block grant, which would cap funding to what is currently an open-ended entitlement. As a child welfare advocate, I also strongly oppose a Medicaid block grant because setting a cap on funding could potentially lead to enrollment caps, reduced services, and out of pocket expenses for children and families who are enrolled in Medicaid on the basis of not being able to afford health care coverage in the private market. Instead of a block grant, the Obama Administration has proposed a blended match to replace the current patchwork of formulas that states currently receive.

In 2006, when Romney was Governor of Massachusetts, he signed a health care insurance reform law which expanded the state's Medicaid program (MassHealth) to tens of thousands of children in families in the commonwealth. While Governor Romney has offered very little specifics around his Medicaid proposal, he has made one thing clear: as President he would repeal the ACA, thereby jeopardizing coverage for current beneficiaries but also eliminating coverage for the tens of millions of Americans expected to gain access to Medicaid under the ACA. According to his website, Romney has endorsed his running mate's plan to block grant Medicaid and offer more flexibility to states as they run their respective programs. He also supports placing limits on federal standards and requirements for Medicaid coverage, thereby restricting the federal government's ability to determine what services states must provide under their Medicaid programs.

Ultimately, the decision will be up to the American voters as they head to the polls in November. In the coming weeks, I want you to ponder a particularly important and poignant question: what vision for America's most vulnerable are you going to support?

One that ensures vulnerable children and families, the disabled, and the most needy have a strong safety net that meets their most pressing needs.

Or one that makes deep cuts to safety net programs for the sake of reducing the deficit, despite the fact that those who rely on these very programs are increasingly in need.