Thank you, Bill Clinton, for reminding us that long-term care is a big part of Medicaid. In his Democratic convention speech this week, Clinton bungled a few of the details, but told a larger truth: Big cuts in Medicaid are likely to mean lost benefits for the frail elderly and younger people with disabilities.
No other major speaker at either convention ever mentioned these consequences of cutting Medicaid. Not Mitt Romney or Paul Ryan, who would dramatically slow federal spending on the program, not Barack Obama, who would maintain the current program but trim spending.
In fact, the issue of long-term supports and services for the frail elderly and people with disabilities was almost entirely ignored by both parties. The importance of expanding home and community-based care got a quick nod from the Republicans. The Democrats were effectively silent.
Republicans have, of course, proposed to turn Medicaid as a whole into a block grant. That would cap the federal contribution to the joint state/federal program. According to the Congressional Budget Office, the 2012 version proposed by GOP vice presidential candidate Paul Ryan would reduce projected Medicaid spending by $800 billion over 10 years.
You might think this is a good idea, and that with increased flexibility governors can run the program more efficiently. You may think is a bad idea. But if we are going to have a debate over the future of Medicaid, we should not forget that one-third of the program’s entire budget–almost $120 billion last year–was spent on long-term care services for the frail elderly and younger people with disabilities. And two-thirds of the program’s budget was spent on all services including health care) for this population.
Medicaid spends almost five times as much per enrollee for the elderly as it does for young adults or kids. And it spends more than five times as much for people with disabilities.
It is true that most Medicaid enrollees are mom with kids. But most of the money is spent on the elderly and disabled. Much as those people are ignored in the policy debate over Medicaid, they are not going away. And it is a scandal when the politicians who argue over the program pretend they don’t exist.