DN Editorial: Messing with Medicaid is messing with the middle class

VICE-presidential candidate Paul Ryan often gets big applause when he pulls out his line about the safety net.

"We don't want to turn the safety net into a hammock," Ryan famously says, "that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives."

Before Bill Clinton brought it up at the Democratic National Convention, squeamishness about caring for the poor (as opposed to the "middle class") had made even progressives reluctant to talk much about the House Republican plan to eviscerate the Medicaid program because it's identified as an anti-poverty program.

Just for a moment, we are going to do the same thing - and put aside the nearly 30 million children from low-income families whose health would be severely compromised if they lost Medicaid coverage. Instead, we ask: Which seniors in nursing homes are the "able-bodied" people being lulled into lives of dependency? What adult children of these frail elderly (who could face bankruptcy caring for them) are interested in lounging in hammocks? Show us the adults with Down syndrome or autism - or the families that struggle to care for them - who are going to be "drained of their will and their incentive to make the most of their lives."

The nonpartisan Congressional Budget Office says that 63.5 percent of federal Medicaid spending ($251 billion) goes for care of an estimated 16 million people who are elderly, blind or disabled. In fact, Medicaid is the principal way that many middle-class families pay for nursing-home care.

So $1.4 trillion in cuts to Medicaid over 10 years, as proposed in the congressional Republicans' budget, would have devastating consequences on the middle class.

The way it is set up, Medicaid goes to people in certain categories, with the costs split between the federal government and the states. In Pennsylvania, the federal government pays 55 percent to the state's 45 percent, and the funding goes up when the needs go up. Under the Republican plan, federal Medicaid money would instead come in the form of a block grant to the states, which would have much greater latitude to decide whom to cover. But the funding wouldn't go up even if the need did, and the results are predictable: Medicaid would cover between 14 million and 21 million fewer people by 2021, according to the Urban Institute.

Compare that with the Affordable Care Act, which not only wouldn't cut Medicaid but would expand it. Under ACA, people with incomes up to 133 percent of poverty by 2014 will be eligible, with the federal government picking up 100 percent of the costs in the first three years, then gradually reducing its share. So if Pennsylvania participates in the expansion, it would mean health-insurance coverage for Pennsylvanians with incomes under $15,415 for an individual and $26,344 for a family of three - that is, not only the poor, but also a lot of working people. It's hard to imagine them taking to their hammocks in response.