An under-discussed aspect of Mitt Romney and Paul Ryan's platform is their proposals to block grant — that is, turn over to the states to control with federal funding support — various programs for the poor, including Medicaid. One likely result of that is that the strength of the social safety net would become heavily dependent on state governments.
The New Republic's Jonathan Cohn has a great piece looking into what this would mean. As Cohn notes in a sidebar, states vary widely in how generous they make certain state-federal partnership programs like food stamps and Medicaid. And the variation within block grant programs, like Temporary Assistance for Needy Families (TANF, or welfare) is bigger still.
Cohn asked the University of Washington's Marcia Myers and the University of Iowa's Sarah Bruch to compare benefits in blue states (ones that voted for Gore, Kerry and Obama) and red states (ones that voted twice for Bush and for McCain), excluding anomalies like Hawaii, Alaska and Wyoming because of geographic factors that make their benefit systems unlike the rest of the country (for instance, Alaska provides a guaranteed income to all residents paid for out of its oil reserves). Sure enough, the blue states were much more generous:
The most startling numbers here are for unemployment insurance and TANF. Welfare now serves only a tiny fraction of those who need it (that is, the total number of poor people in the state in question), and even in blue states, unemployment insurance only covers about 60 percent of people who need it (that is, the total unemployed). Not coincidentally, these are the programs where states have the most amount of control. TANF is a block grant program, established by the welfare reform law of 1996 as a replacement for the federally funded, state-administered Aid to Families with Dependent Children (AFDC). And unemployment insurance, while operating under federal guidelines, is solely funded by state taxes, usually on employers.
By contrast, food stamps, Medicaid and S-CHIP — all state-federal partnerships but not block grants — are much more even between the states, and cover much more of the eligible population. They accomplish what they're designed to accomplish more effectively and equitably than the programs where states have more leverage.
You can also see this if you look at state budgets. Cohn highlights the work of Curtis Skinner at the National Center for Child Poverty, who has measured the amount each state spends on social programs. The states that spend the most tend to be low-poverty blue states and high-poverty red states in the South:
Minnesota, which has a very low poverty rate, spends about as much as Tennessee, which has a much higher rate. This translates into Minnesota's welfare state being more generous, since it's spending the same amount to serve a much smaller needy population. Indeed, the states with the highest ratios of spending to poverty (that is, those that are spending the most relative to the size of the problem) tend to be blue states:
None of this is especially surprising. People in blue states, by definition, vote for Democrats, who tend to pass more expansive social legislation. But it does drive home how uneven social policy is today, even without block grants. With block grants, it'll matter even more what state you find yourself in.