A World Without Medicaid…

As the election cycle continues, Governor Mitt Romney has been increasingly pressed to clarify his position on Medicaid (Medi-Cal in California).  President Obama’s position, of course, is to expand Medicaid eligibility under the Patient Protection and Affordable Care Act, commonly known as Obamacare.  For most of the election, Governor Romney’s position has been overturning Obamacare.  However, his position has been somewhat perplexing, since “Romneycare,” the health care plan in Massachusetts, is similar.  Recently, Governor Romney has made appearances on shows like 60 Minutes to attempt to lend some clarity to his alternative proposal, resulting in more remaining questions than answers.
Often people think of Medicare as being the program for the elderly and Medicaid being for low-income people.  However, low income seniors are generally covered by Medicaid.  Additionally, Medicaid often covers long-term care for seniors who can’t afford it.  So while the $700 billion redirected from Medicare has been a major point of contention between the candidates, the Medicaid issue is really the focal point for medical planning and end of life care.

Governor Romney’s newest proposal, which he discussed in his 60 Minutes interview, is to issue block grants to states to cover their own Medicare programs.  From there, the states would be obligated to craft their own health care plans to help their poor with the budget they are given by the federal government and whatever the states contribute.  In the future, the amount paid would be increased by inflation plus 1%.  Essentially over time, the federal government’s growth in Medicare expenditures would be limited, theoretically saving taxpayer money.  However, there is no indication at this point what type of program the states would have to create or whether there would be any requirements. Under Romney’s plan, cash-strapped states would be left to face rising health care costs on their own, which could easily create 50 of the same problem we have now: the increasing percentage of our budget being allocated to health care entitlement plans.

When asked whether he believed we have a responsibility to care for low-income, uninsured individuals, Governor Romney acknowledged that we do care for the uninsured.  However, he implied that the states would be better equipped to handle individuals through their hospital emergency rooms and seemed to be saying the care is free.  Of course, the care is not free and medical bankruptcies have been an increasing problem.  The most puzzling aspect of his statement is that Governor Romney also stated, two years ago, that he did not believe people should be treated through emergency rooms for free.

At this point, Governor Romney ought to clarify his plan for Medicaid so that voters can make an informed decision about his policy.  The debate over Medicaid is not simply about whether the state or federal government will foot the bill; it is instead about whether seniors can count on and plan for eligibility for long-term and end of life care in the event it’s needed.  Perhaps more answers will be forthcoming at the October 3 Presidential debate on domestic policy!