Wait a Minute…Medicaid Reform Means Spending Less Money on Medicaid?


Whatever you do, don't call it a campaign speech. On Tuesday, President Obama gave a speech attacking House Republicans and the GOP Budget Committee Chairman, Paul Ryan, for doing something that the Senate, under the control of Democrats, haven't been able to do in more than 1,000 days: pass a budget.

President Obama described Ryan's budget, which according to the Congressional Budget Office wouldn't balance the federal books until 2039, as a "radical vision" and warned that "one of my potential opponents, Governor Romney, has said that he hoped a similar version of this plan from last year would be introduced as a bill on day one of his presidency" and joked about Romney's use of the word "marvelous" to describe Ryan's plan.

An election year extended attack on the other party's budget plan that explicitly ties the all-but-certain opposition nominee to its proposals? Most people would call that a campaign speech. But not the Obama White House—which, according to The Hill, "strongly denied that President Obama's attack on the GOP budget was a campaign speech." Instead, according to administration spokesperson Jay Carney, it was "a policy speech" that "had a lot of detail attached to it."

What he didn't say was that some of that detail was misleading, or just wrong.

Here, for example, is what the president said about the Ryan budget's proposed Medicaid overhaul:

The states can experiment.  They'll be able to run the programs a lot better.  But here's the deal the states would be getting.  They would have to be running these programs in the face of the largest cut to Medicaid that has ever been proposed—a cut that, according to one nonpartisan group, would take away health care for about 19 million Americans—19 million.

This makes it sound as if Ryan's budget would cut off health coverage for 19 million people immediately. But as Rep. Ryan notes on his Facebook page,* 19 million people is the number of people expected to be enrolled in Medicaid under ObamaCare in the years after 2014, when the major coverage expansions kick in.** [See update below.] So all that really means is that the Ryan budget would repeal ObamaCare, which for the last two years has remained more popular than letting the law stand.

And what about those giant cuts the states would face? Again, Obama's description makes it sound as if the Ryan plan would take a chainsaw to the Medicaid budget starting tomorrow at sunrise. In fact, even under the most pessimistic projections, the changes would take place over 10 years. Spending in 2014 would be held roughly to 2012 levels (about $256 billion)and then allowed to rise from there; the rise, however, would not be as fast as under the current baseline. So sure: It's true that over the next decade, the federal government would spend less on Medicaid under Ryan's plan than on its current trajectory. But that's the whole point.

Getting the federal budget under control means spending less than current projections forecast. In the long term, it mostly means getting federal health spending under control. Ryan's budget, which passed in the House, contains a number of proposals that would help start this process. Senate Democrats haven't shown any interest in passing anything that would even get it started. As for President Obama, well, I'll leave it to Timothy Geithner to explain the administration's position: "We don't have a definitive solution to our long term problem…we just don't like yours." But remember, this is all just policy, not politics. 

*It's the future, and this is apparently how these things work now.

Update: A emailer notes that Obama may be getting his 19 million figure from this Kaiser Foundation report, which on page five projects that by 2021 the block grant overhaul in the 2011 version of the House budget would result in Medicaid enrollment being reduced by about 19 million people in addition to those people who would no longer get coverage through ObamaCare. (According to the Center for Medicaid and Medicare Services, the new health law is also expected to increase Medicaid coverage by about 19 million individuals.) But even this is not as drastic a change as it sounds: Reducing Medicaid coverage to a little more than 39 million individuals, as Kaiser projects, would still only roll coverage totals back to roughly the levels they were at between 2002 and 2003. Given the massive problems with Medicaid both as a budget item and a medical benefit, it doesn't seem unreasonable to be wary of a program that consistently causes headaches for both taxpayers and patients. 

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  1. Obama (or most politicians, really) moves his lips and all I hear is blah, blah, blah, fuck you, blah, blah.

    1. “It’s time for someone who has the courage to stand up and say, I’m against those things that everybody hates!”

      1. MY LIFE FOR YOU!

        Boom de BOOM!

      2. it is time we stood up to those who would kill our kittens, kick our puppies and starve our children.

        1. Stand up to them? I’m VOTING for them.

      3. “I say your 5cent titanium tax goes to far!”

        “And I say your 5 cent titanium tax doesn’t go to far enough!”

  2. “spend less money”?

    I know the words are English, but the way you put them together they just don’t form any sensible meaning.

    1. Yes, it is an odd and foreign concept.

      I think what he meant to say is, “Spend less than we originally planned.” That’s bad, but at least it makes sense.

      1. That does sound pretty scary. How about this instead: “Spend the same amount but adjust the expected expenditures upwards.”

  3. There are those who say it’s not so much the money as it is the amount.

    To those people I say, “You’re right. And spending less means you hate children. Why do you hate children?”

    1. God, one of the rhetorical devices that I fucking hate when people use are weasel words like, “There are those who say…” or “Some people think…”

      Who? Name me fucking who, so I can go kick them in the nuts or shake their hand.

      1. According to experts…

      2. There are those that say that some people think you have sand in your vagina.


  4. Because bankrupting the country and stealing every dime that is not nailed down is the compassionate thing to do.

    1. You forgot the enthrallment, serfdom and indentured servitude. All for the “greater good”. Of course.

    2. Compassionate conservative?

      You’re describing the years immediately preceding Obama’s presidency.

      But for some reason the wealthy can’t steal. They can only get more of what’s rightfully theirs.

      1. More than the wealthy are stealing, the politicians and bureaucrats are giving away future tax proceeds to the highest bidder. Whether that bidder is Lockheed Martin, Goldman Sachs, the AARP, or ACORN.

        So when you go on bitching about the wealthy who live better than I, I’m more worried about the ones with the guns who are going to come collecting in the future.

  5. I wonder what Obama’s reaction would be to my proposal, the elimination of Medicaid and free market health care? Head explosion?

    1. And you would keep on wondering until your house was hit by a drone strike. Terrorist.

    2. the elimination of Medicaid and free market health care

      He’s willing to meet you halfway.

      1. Zzzzzzzzzing! This is why we need to properly parse our language; poorly worded Wishes like this are how you get your PCs aims thwarted in DnD.

        Um, I mean, boobs and sports.

        1. LULZ!

        2. I have it on good authority that only shitty GMs screw over players like this and they should be forced to stick to the letter of the law except when the spirit of the law would give the PCs a better outcome.

          1. “I rolled shit stats so I can’t adventure! Without adventuring, I can’t amass immense wealth! We need someone running this campaign who has the interests of the common man in mind. Inherent Bonuses to WIS are a RIGHT, not a privelege, and anyone who tells you differently is just waiting for their chance to make rocks fall so everyone dies.”

            TOP. GMs.

            1. “This chart right here shows how much loot I SHOULD have at this level and I’m way short of that. How do you expect us to keep up with difficult encounters if you keep screwing us over on gear? You’re the worst GM I’ve ever seen.”

              1. “Look, if I wanted to get shoe-horned into a single role instead of multi-classing 17 times over 18 levels, I’d have played 4thED. You’re basically a fascist.”

    3. My guess is something along the lines of, “Are you serious!? Are you serious!?”

  6. If they really wanted to cut the budget they’d have every department ask for a 100% increase in their budget, then only increase their budgets by 10%.

    Voila, a 90% cut in spending!

    1. That is pretty much what they did. The porkulus basically doubled baseline non defense/entitlement spending. So to go back to the small government let children starve days of George W now requires a 50% cut in spending. 50%, don’t you know how radical that is?

      It would be funny if it wasn’t so dangerous and pathetic.

      1. The stimulus didn’t do a damn thing to the budget since it was supplemental.

        And it certainly came nowhere near “doubling entitlements” like you falsely claim. Medicare provider CUTS are already kicking in, you idiot.

        1. doubled baseline non defense/entitlement spending.

          I know you are retarded. But Non means “not that”. And the fact that it was supplemental doesn’t mean it didn’t raise baseline spending. All spending is supplemental since the Democrats refuse to pass a budget.

          No go back in your hole you retarded little sock puppet.

          1. John, come on, man…ignore. Just walk away.

            1. I know. Notice Tony showed up too. There may have been a real Tony and a real Shreek at one time. But they are both now sock puppets.

        2. Hey everybody, shriek’s here! Now we can all look forward to an afternoon of intellectually vapid democratic party talking points repeated ad nauseum logical, well thought out, reasoned debate.

        3. Medicare provider CUTS are already kicking in, you idiot.

          No shit, Shriek-lock. That’s why I got out of being a CMS provider almost two years ago. I wasn’t going to take the hit and extra bending over more than providers already get.

          Oh, and you forgot cuts to TRICARE which are also kicking in even as we speak. Dipshit.

          But once again, you willing doofus, other areas of Fed to State ATM have increased entitlement spending, yanno, under that nebulous discretionary spending siphoned out of the general fund?

        4. Those are cuts to what providers get paid.

          Not cuts to benefits.

          Which is why the Medicare budget jes’ keeps on agrowing.

          There is no sustainable way to bring Medicare spending under control without cutting benefits.

          If you cut provider payments enough to “bend the cost curve” to solvency/sustainability, you will drive providers out of the system (many via bankruptcy).

      2. Can we also bring up how ridiculous it is that military spending must always increase, always, when the guys who we are ostensibly ramping up this spending to fight live in caves, use old AKs, and make bombs on the cheap?

        I mean, we’re using a 1 million dollar bomb to kill a guy who makes 50 cent bombs.

        1. That’s progress, doncha’ see?

  7. Why can’t someone in the court media ask the black Jesus if balancing the budget by 2039 is too radical, what isn’t radical?

    1. Let me be clear: I’m all for balancing the budget as long as that means I can continue spending your money like drunken sailor on shore leave in Bangkok.

      1. Drunken sailors spend their own money.

  8. OT: Good to see the Pirates are in mid-season form already, got shutout by the Phillies on opening day.

  9. Peter, on spending, you only need to remember three simple words: We are screwed.

    Actually doing anything to reduce spending is going to take away someone’s pony, and when you take away someone’s pony, they don’t vote for you. So polticians have learned not to take away anyone’s pony, ever, even if they sometimes say they will take away someone else’s pony, because that person doesn’t deserve a pony (fill in the blank: Republicans it’s welfare queens, Democrats its rich people).

    Honestly, my advice is to buy a gun. The London riots will look calm compared to what is going to happen in the US when it all blows up.

    1. Actually doing anything to reduce spending is going to take away someone’s pony, and when you take away someone’s pony, they don’t vote for you. When they don’t vote for you, you don’t get elected. When you don’t get elected you have to take a second job as a clown on K-Street. When you take a second job as a clown, your friends and family shun you. When your friends and family shun you, you are known as that creepy clown guy at the end of the street.

      Don’t be the creepy clown guy at the end of the street. Don’t cut spending.


        If it’s good enough for the heathen Gawkerites, it’s good enough for us!

        1. You don’t want to start imitating Gawkerfucks. That’s a dangerous road to hoe and an even more dangerous lion to tow.

      2. Nice.

        I love those commercials, BTW. The one about not winding up in a roadside ditch is a classic for the ages.

        1. I like the one where the guy grows the beard and ends up taking in stray animals. But the best one is the baby with a dog collar.

          1. And, let’s face it, re-enacting scenes from Platoon with Charlie Sheen is not a road anyone should walk.

  10. My contempt for our political class is still in its exponential growth phase. I would have expected it to level off at some point, but no.

    Fuck this shit. You get a baby otter.

    1. But I was promised a pony! I want my fucking pony!

    2. That is a little cutie!

    3. Shock and awwwww?

  11. I have lived for more than half a century. I remember Kennedy and Nixon. I have never seen a president with less respect for the American people than this piece of Obama shit.

    His lies are worse than Nixon’s.

    1. Nixon hated his enemies. Obama seems to hate the entire country.

      1. He really does.

        1. Speak for yorself!

      2. The Left’s enemies are internal. Always have been. They DO hate the nation.

    2. I think Obama is just the classic academic: He’s so smart and he knows better than anyone else what’s good for America.

      I’m sure if radio had existed, Wilson would have sounded the same way.

      1. He’s not an academic. That’s bullshit, too.

        1. No shit. He taught adjunct at Chicago for a couple of years. BFD.

          1. I taught banking law an adjunct for a few years probably about the time he was “teaching” Con Law, but I know better than to spout off about banking law now.

            1. I turned down an adjunct job at the law school here (pays shit and is way out of my way), but I was in research at a major university back in the 90s. If I ever run for office, I won’t be calling myself an academic or allowing people to suggest that I’m one.

    3. He just doesn’t give a shit. Nixon gave a shit, in his own paranoid, screwed up way. Obama is the presidential equivalent of “whatever, fuck you, I don’t care”

      1. For all of Nixon’s faults, when push came to shove and they told him “hey you need to resign and not fight this for the good of the country” he resigned. Obama would never do something like that. He doesn’t give a shit about anything or anyone but himself and maybe his nasty wife and screaming brats.

        1. Being a hate-filled pig shortens your life. I recommend a month vacation from FOX News.

          1. If this is true, why aren’t you dead yet?

          2. Shut up sock puppet.

            1. Do you think I ever have spoken an ill word about Laura Bush? Seriously, you have issues.

              Okay there was that one time she wore the same dress as two guests to a white house christmas party and I poked fun, but she did change and I applauded her hostessing skills.

              You have some nerve calling me a sockpuppet. The noises that your jaw and Hannity’s ass cheeks make when they flap are indistinguishable.

        2. Nasty wife – I’m with you there.

          His kids, though – off limits, IMO.

          1. Yeah. I like the kids.

          2. Um, there was that recent Spring Break trip to Mexico for the oldest daughter on the taxpayers dime. Even you must admit that was beyond necessary and not above reproach. I blame the parents more, but I doubt letting her go to Mexico sans the fam was the parents’ idea.

            1. Supposedly it was actually a school trip. To which I say: What the fuck? I never got to go out of country for school trips.

            2. Who knows?

              Still: kids = off limits.

      2. Ever see clips of Nixon speaking to protestors near the White House after Kent State? Bottom tier president, but he definitely gave a shit.

        1. I thought that was at the Jefferson Memorial.

  12. Eh, why the hell not:

    Federal spending on healthcare in 1980: $55 billion ($150 billion, inflation-adjusted)

    Federal spending on healthcare in 2011: $800 billion

    Until anyone screaming “what about the children/poor/elderly/etc.?” can actually show, using real math with real statistics, how their proposals will nuke that 9% annualized cost increase, there’s nothing more that needs to be said on healthcare “reform.”

    1. And are we getting over five times the quality and quantity of health care now than we were in 1980? Because that is adjusted for inflation what we are spending for it. But nothing went off the rails or anything.

    2. “After a few years of DeanCare, you won’t have to worry about health care for the poor/elderly/children/etc. Problem. Solved! You’re welcome.”

  13. Let’s remember that President Obama is going to consider any budget proposal radical that doesn’t eliminate deficit spending primarily with increased tax revenue.

    1. Let’s remember that President Obama is going to consider any budget proposal radical that doesn’t eliminate couple increased deficit spending primarily with increased tax revenue.


  14. It is unbelievable that both parties plan to run up the debt and deficit even more. Is it really that significant that Ryan’s plan is to increase the deficit less than Obama would increase the deficit?

    Just recently the CBO reported that if laws remain unchanged the federal budget deficit for this year will be $1.1 trillion (http://1.usa.gov/xju6K9). That is in addition to total debt over $15 Trillion and projections that by 2021 federal debt will be over $20 trillion (http://1.usa.gov/wt4DPi).

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