Ryan’s Medicare Plan Is Horrible, but His Medicaid Plan Is Worse

Vice Presidential candidate and House Budget Committee Chairman Paul Ryan in March 2012

Photo by Chip Somodevilla/Getty Images

The hot election issue in this country right now is 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 is another issue that we should be talking about just as much if not more: Medicaid. Because unlike the proposed Medicare changes 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—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. The nonpartisan, universally respected Congressional Budget Office calculates that a minimum of 14 million people would be 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 people gaining coverage—and the Ryan plan—which will lead to about 25 million losing coverage—could not be more stark.

Play this scenario out a bit more. What will happen when these 25 million lower-income Americans need care? Some of it will be paid out of pocket, 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 is good that we are talking about the Medicare issues in the campaign, but let’s spend a few minutes talking about Medicaid as well.