Medicaid shapes up as major battleground

Mitt Romney’s choice of Rep. Paul Ryan (R-Wis.) as his running mate has reignited a debate over the future of Medicare. But Ryan’s proposed cuts to Medicaid, the other huge federal health program, could have quicker and more far-reaching consequences, with the potential to dramatically affect state budgets and health care for millions of people.

Ryan has proposed scaling back the nation’s four-decade-old insurance program for the poor and disabled — bringing down the cost by $810 billion over 10 years. The measure is part of a budget he has said aims to avert “an epic collapse of our health and retirement programs that would devastate our nation’s most vulnerable citizens.”

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Ryan, who chairs the House Budget Committee, also wants to give states their Medicaid contributions in “block grants,” or set amounts, each year. States would get more flexibility, with the expectation that they would be able to use the money more efficiently and creatively.

But experts say the cutbacks are so dramatic that it would be impossible for states to innovate their way out of massive cuts to a program that in 2010 served some 54 million Americans, roughly 6 million more than Medicare. “There’s always great interest on the part of Republican governors and conservatives in block-granting Medicaid, and it is always framed as a debate about flexibility. But it never is,” said Drew Altman, president of the nonpartisan Kaiser Family Foundation. “Really, it is all about money.”

The debate echoes one that has become central to this year’s presidential race, on the role of government and the best way to address the nation’s burgeoning deficit. By choosing Ryan, Romney has gambled that voters, in the name of deficit reduction, are willing to stomach the idea of cuts they previously rejected.

Though Romney has praised Ryan’s plan broadly, he has suggested without elaboration that he disagrees with some parts of it. However, Romney has endorsed the idea of converting Medicaid into a block grant program.

The recent attention to Medicare reflects a political reality — the program affects a much more engaged voting bloc, senior citizens, whose support can make or break a candidate.

No matter who is elected, Medicaid likely will be the subject of fierce debate in coming months, as the government continues to roll out changes under President Obama’s new health care law and lawmakers on Capitol Hill begin to tackle the national debt.

Medicaid emerged as a flashpoint in late June when the Supreme Court struck down a requirement under the health law that states expand eligibility to the program, ensuring that about 17 million more Americans would gain health coverage. Some Republican governors have since announced they will not go along with that expansion.

Budget experts say Medicaid is likely to again become a major issue as Congress begins to tackle the “fiscal cliff” — when a number of budgetary deadlines coincide and lawmakers are expected to hash out a strategy for addressing the national debt.