Vice President Joe Biden was in Minnesota this week, campaigning for his boss, President Barack Obama.
During a speech in Minneapolis, Biden spent some time talking about vice presidential candidate Paul Ryan’s budget plan. There’s a lot about the proposal that Biden doesn’t like, including how Ryan treats the Medicaid program.
The bill makes “massive cuts in Medicaid, throwing 19 million people off their health care including 1 million seniors. People, many of whom were thrown on to Medicaid because they lost their job through no fault of their own,” Biden said.
In one case, Biden’s claim is plausible. But how Ryan’s plan would affect Medicaid enrollment depends on how states manage changes to the program.
Medicaid covers poor children and adults, the disabled and some elderly people who need long-term care. The federal government and state governments share the cost of the program.
Those over 65 make up a relatively small share of the program’s enrollees – about 10 percent – but because their care is long-term and expensive, this group accounts for roughly 20 percent of Medicaid’s expenditures annually, according to a 2011 Centers for Medicare and Medicaid Services report.
Ryan, who is chairman of the House Budget Committee, has proposed trimming federal Medicaid spending by $800 billion over 10 years and transforming the program into a block grant program. That means states would get fewer federal dollars but have more flexibility in who they cover and what benefits they provide.
Ryan’s plan would also repeal Obama’s health care law.
If Ryan’s plan were put into law, the number of people on Medicaid would depend a lot on how states adjust to the cuts.
Back in May 2011, the Kaiser Family Foundation Commission on Medicaid and the Uninsured looked at how Ryan’s plan would affect Medicaid in three different ways.
If states spend the same amount on each enrollee over the next 10 years but cut the number of beneficiaries equally across all groups, 19 million people would be booted from the program. An additional 17 million would have to find health care elsewhere if the health care law were also repealed, as Ryan’s budget proposes.
Under this scenario, about 40 million people would remain on Medicaid in 2021 – about 36 million fewer people than what’s expected if no changes are made to the program.
This scenario also assumes that some seniors would be cut from the program, but the report doesn’t say how many. However, because the cuts would be made in equal proportions across all Medicaid groups in this scenario, it’s not unreasonable that somewhere in the range of 1 million seniors could lose their benefits.
All those numbers change somewhat if states do more to protect the elderly and disabled from Ryan’s cuts or if they scale back how much they spend per every enrollee, but they’re all in range of what Biden claimed.
Under one possible scenario laid out by an organization known for its non-partisan health policy analysis, Biden’s claim is in the ballpark.
But his estimates come with a lot of uncertainty. If Ryan’s proposed Medicaid changes were ever adopted, much would depend on how the states manage those changes, whether they would choose to cut benefits or enrollment equally across all groups, or opt to protect seniors and the disabled over adults and children.
MPR News, Biden rips into Romney in Minneapolis, by Tom Scheck, Aug. 21, 2012
Kaiser Family Foundation, House Republican Budget Plan: State-by-State Impact of Changes in Medicaid Financing, May 2011
Kaiser Health News, FAQ: Ryan’s Plan Would Make Key Changes In Medicaid, Too, by Mary Agnes Carey, Aug. 14, 2012
Bloomberg News, Medicaid Cuts Ryan Doesn’t Tout Would Cut Aid To Seniors, by Brian Faler, Aug. 15, 2012
The Centers for Medicare and Medicaid Services, 2011 Actuarial Report On the Financial Outlook for Medicaid, March 16, 2012
Associated Press, The other Paul Ryan plan: $800 billion in Medicaid cuts, by Ricardo Alonso-Zaldivar, Aug. 15, 2012