by Chris Bodenner
Readers continue to be better spokespeople on this issue than Debbie Wasserman Schultz:
The big effect Ryan's plan would have right way on the over-55 set is the change to Medicaid spending. Block grants to the states for Medicaid would not keep pace with health care cost growth, thus either forcing states to pay more and more (and raise taxes to fund these payments) or spend less on Medicaid. About 50% of Medicaid spending [pdf] is consumed by the elderly (though they comprise only about 20% of the recipients) and most particularly about 50% of all long-term care in this country is at least partially funded by Medicaid.
Another:
Debbie certainly does screw up here. Current seniors are impacted by the Ryan plan, but not in the way she tries to explain it. Medicaid provides the final safety net for most seniors who become chronically ill in old age. After they burn through all of their assets and family assistance, seniors end up in nursing homes on Medicaid. If you haven't noticed, Ryan also gets rid of Medicaid as we know it, by cutting spending sharply (and soon) and block granting to states.
Also, it is not ridiculous to think that today's seniors actually care how their children and grandchildren will fare in retirement. So it's not unreasonable for them to look at voucherizing Medicare and seeing that it just won't work for their own families.
Another speaks from experience regarding the Medicare-Medicaid connection:
The current Ryan budget will impact today's seniors immediately, due to its cuts to Medicaid. I blog about dialysis; here's how the Ryan budget plays out in the provision of dialysis:
Medicaid is an important part of the dialysis payer mix. Among the ~400,000 people using dialysis in the US, Medicaid is the primary insurer for over 10% and Medicaid is the secondary payer to Medicare for nearly 40% of all Americans using dialysis (the "dual eligibles", who need Medicaid to pay the 20% left by Medicare). It is accurate to say ~50% of the people using dialysis rely on Medicaid for at least part of their funding.
The care every dialyzor receives is based on the average reimbursement at a unit. In a dialysis unit everyone uses the same machines, the same doctors, the same staff following the same policies and procedures, no matter how much your care is reimbursed. Even if you are in the first 33 months of using dialysis and are insured through an Employer Group Health Plan that is paying many times more than the Medicare (and by extension Medicaid) allowed rate, your care, the level of care available to you, is based on the average reimbursement rate at that clinic.
The Medicaid cuts in the Ryan budget take effect immediately. Lower Medicaid reimbursement means more states will be paying less than 100% of the Medicare allowed rate, which means there will immediately be a lower average reimbursement for each treatment. A lower average reimbursement rate means less funding for the care everyone receives. The unit’s policies and procedures, its staffing levels, how often equipment is maintained/replaced all depend on the unit’s average reimbursement. When that goes down, services decline. So beyond those with Medicaid as their secondary insurance, Medicaid cuts affect everyone who uses dialysis.
The Dish 