The Guardians Michael Tomasky: Harold Pollack, the University of Chicago healthcare expert wrote me an email, which I henceforth reproduce for your edification, here:
They're not ending Texas Medicaid.
Given Medicaid's enormous costs and the politically vulnerable constituencies the program visibly serves, it's not surprising that emboldened Texas conservatives speak of abolishing Medicaid in their state. Before anyone gets too deep into this, it's worth noting that the whole idea is financially, organizationally, and politically disastrous. Were it not for the serious human consequences that would ensue, liberals might ardently hope that Texas Tea Party-types seriously pursue this effort.
From an economic perspective, the federal government pays the lion's share of Texas's Medicaid costs … Texas's federal matching rate exceeds 60 percent … feds will pay virtually the entire tab for people made newly-eligible for Medicaid through health reform.
Medicaid is hard-wired within the payment systems and the business models of thousands of medical providers. It is also the conduit through which many services are provided in nonprofit agencies, schools, and other settings.
Then there is one final point. The owner of this space has noted the disjunction between Americans' professed belief in the general virtues of limited government and our actual support for particular costly programs that serve ourselves and others we want to help. That will matter here. Many people believe that Medicaid serves stereotypical poor people. Indeed, most Texas Medicaid recipients are low-income kids.
Yet the dollars tell a different story. Almost 60% of Texas Medicaid dollars cover services to the elderly or the disabled. Lawmakers may expect that slashing Medicaid will produce ardent but ineffective protests from traditional Democratic constituencies. But legislators may instead encounter surprising numbers of angry Good ol' Boys asking what the hell happened to the nursing homes and visiting nurse agencies that help their elderly parents, or why their cousin's autistic child suddenly can't get services through his local school. I'm still confident that blustering politicians who go this route will soon be seeking other work.
ME AGAIN: So gutting Medicaid means..well, imagine those horror stories - throwing people out of nursing homes. Who'll be making those decisions? Unlike last year, this time, "death panels" might actually be not too far away from the truth.