And if states decided to drop dual eligibles — the most chronically ill people in the society — from the Medicaid program, it would not only drive up Medicare costs sharply but likely leave many of these cases in limbo. Medicare does not provide long-term care, much less the kinds of Medicaid-funded day programs for those with mental and physical disabilities that allow some to live with families while enabling relatives to work.
Romney did say that if states got into trouble the government could always find ways to help. But to do so would conflict with all the other promises of fiscal restraint. The money would have to come from somewhere, and he has ruled out defense and Medicare and promised deep cuts in discretionary spending.
Finding ways to restrain future growth in health care spending is an urgent priority. But Medicaid is already far more efficient than private health programs or Medicare, in large part because reimbursement rates to providers are ridiculously low. Cutting rates to providers would be counterproductive, and needs under the program, especially for the most sick among us, are likely to grow. Repealing the health care overhaul and making Medicaid a block grant are, at best, inadequate responses.
Norman Ornstein is a resident scholar at the American Enterprise Institute.
Rep. Bill Cassidy has his blood drawn by Alesha Barbour during a free hepatitis screening in the Rayburn House Office Building hosted by the Congressional Viral Hepatitis Caucus to recognize "National Viral Hepatitis Testing Day."
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