Time and time again, House Budget Committee Chairman Paul Ryan has proposed budgets that would gut Medicaid and take health care away from millions of Americans. The Koch-funded Americans for Prosperity has repeatedly been right by his side.

AFP supported Rep. Ryan’s 2013 budget proposal, which would have turned Medicaid into a block grant program and cut spending by $810 billion over ten years. They also supported his 2012 budget plan, which would have turned Medicaid into a block grant program and eliminated federal coverage mandates.

The Kaiser Family Foundation estimated that under that plan, 14 to 27 million Americans would have lost Medicaid coverage, and the Congressional Research Service warned that costs would have been shifted back to the states, making it difficult for states to maintain their current Medicaid programs.

When examining AFP’s record on this issue, it’s important to bear in mind the groups of people served by Medicaid: Almost half of its recipients are children, and another quarter are either elderly or disabled.

2012

AFP supported FY2013 Ryan Budget, Which Would Have Cut $810 Billion In Medicaid Spending Over Ten Years. In 2012, AFP supported cutting $810 billion in Medicaid spending over ten years, as part of House Budget Committee Chairman Paul Ryan’s (R-WI) proposed budget resolution covering fiscal years 2013 to 2022. According to the Congressional Research Service, “The unofficial estimate provided in Chairman Ryan’s ‘Path to Prosperity’ report states that the proposed budget would reduce federal outlays for Medicaid by about $810 billion over 10 years. When compared to CBO’s baseline projection for federal Medicaid spending, the proposal would reduce federal Medicaid outlays by 17.6 percent from FY2013 to FY2022.” The vote was on passage; the resolution passed by a vote of 228 to 191. The Senate took no substantive action. [House Vote 151, 3/16/12; CRS, 3/29/12; AFP Scorecard for the 112th Congress, 2/1/13; CRS Report #R41767, 4/13/11]

• Ryan’s Budget Suggested Repealing Affordable Care Act’s Medicaid Expansion To Make Cuts. According to the Congressional Research Service, “The Medicaid provisions of ACA represent the most significant reform to the Medicaid program since its establishment in 1965. In general, ACA (1) raises Medicaid income eligibility levels for nonelderly individuals up to 133 percent of the federal poverty level, (2) adds both mandatory and optional benefits to Medicaid, (3) increases the federal matching payments for certain groups of beneficiaries and for particular services provided, (4) provides new requirements and incentives for states to improve quality of care and encourage more use of preventive services, and (5) makes a number of other Medicaid program changes. The major expansion and reform provisions in ACA are slated to take effect in 2014. One of the “illustrative policy options” offered in the House Budget Committee report (H. Rept. 112-421) includes repealing the Medicaid expansion included in ACA.” [CRS, 3/29/12]

2011

AFP Supported FY 2012 Ryan Budget, Which Would Have Converted Medicaid To A Block Grant And Eliminated Federal Coverage Mandates. In 2011, AFP supported converting Medicaid to a block grant and eliminating federal coverage mandates, as part of House Budget Committee Chairman Paul Ryan’s (R-WI) proposed budget resolution covering fiscal years 2012 to 2021. According to the House Budget Committee, the budget would “convert[] the federal share of Medicaid spending into a block grant tailored to meet each state’s needs, indexed for inflation and population growth. […] States will no longer be shackled by federally determined program requirements and enrollment criteria. Instead, they will have the freedom and flexibility to tailor a Medicaid program that fits the needs of their unique populations.” The vote was on passage; the resolution passed by a vote of 235 to 193. [House Vote 277, 4/15/11; House Budget Committee, 4/5/11; AFP Scorecard for the 112th Congress, 2/1/13; CRS Report #R41767, 4/13/11]

• CRS Said That Ryan’s Proposal Would Shift The Cost Of Medicaid To The States Which Would “Make It Difficult For States To Maintain Their Current Medicaid Programs” Potentially Leading To Reduced Payments To Providers, Benefits Cuts Or Eligibility Restrictions. According to the Congressional Research Service, “this proposal would shift the responsibility for the growth in Medicaid spending over the federal block grant amount to states. According to CBO, “the magnitude of the federal Medicaid spending reductions under this proposal would make it difficult for states to maintain their current Medicaid programs. As a result, states would have to weigh the impact of maintaining current Medicaid service levels against other state priorities for spending. They could choose to constrain Medicaid expenditures by reducing provider reimbursement rates, limiting benefit packages, or restricting eligibility. These types of programmatic changes could also impact access to and the quality of medical care for Medicaid enrollees. For example, if states reduced the Medicaid reimbursement rates to providers, such as hospitals, physician, and nursing homes, these providers may be less willing to accept Medicaid patients.” [CRS Report #R41767, 4/13/11]

• Ryan’s Plan Would Have Reduced Medicaid Spending by $750 Billion over 10 years. According to the House Budget Committee, the budget’s Medicaid Proposal would “Save $750 billion over ten years, contributing to the long-term stabilization of the federal government’s fiscal path and encouraging fiscal responsibility at the state level.” [House Budget Committee, 4/5/11]

• Currently, Medicaid Is An Entitlement Program, Which Means States Have Guaranteed Funding For Part Of The Costs Of Coverage And It Will Cover Providing Benefits To All Who Legally Qualify. According to the Center on Budget and Policy Priorities, “Medicaid is an ‘entitlement’ program, which means that anyone who meets eligibility rules has a right to enroll in Medicaid coverage. It also means that states have guaranteed federal financial support for part of the cost of their Medicaid programs.” [Center on Budget and Policy Priorities, 5/8/13]

• Ryan’s Plan For Block Grants Would Cause Roughly 14 Million To 27 Million People To Lose Medicaid Coverage By 2021. According to the Kaiser Family Foundation, “In the second scenario, states are able to slow annual increases in Medicaid spending per person to match growth in the economy as a whole.[…] Medicaid enrollment in 2021 would fall by […]13.8 million from the block grant). […]In the third scenario, states protect eligibility for the elderly and disabled (thus disproportionately making enrollment cuts among adults and children). […] Medicaid would cover 43.8 million fewer people in 2021 than under current projections ([…] 26.8 million from the block grant). [Kaiser Family Foundation, 5/2011]

• Medicare Provided Coverage To 67 Million People In 2012, Including 32 Million Children 19 Million Adults, 6million Seniors And 11 Million Disabled. According to the Center on Budget and Policy Priorities; “In 2012, Medicaid provided health coverage for 67 million low-income Americans over the course of the year, including 32 million children, 19 million adults (mostly low-income working parents), 6 million seniors, and 11 million persons with disabilities, according to Congressional Budget Office estimates.” [Center on Budget and Policy Priorities, 5/8/13]

• Children Account For About Half Of Medicaid Enrollees. According to the Center on Budget and Policy Priorities; “Children account for nearly half of all Medicaid enrollees but just one-fifth of Medicaid spending.” [Center on Budget and Policy Priorities, 5/8/13]

• Medicaid Programs Are Operated By The States With Minimum Eligibility Requirements Set By The Federal Government. According to the Center on Budget and Policy Priorities, “In order to receive federal funding, states must cover certain ‘mandatory’ populations: children under age 6 in families with income below 133 percent of the federal poverty line ($25,975 for a family of three in 2013); children aged 6-18 in families with income below the poverty line; pregnant women with income below 133 percent of the poverty line; parents whose income is within the state’s eligibility limit for cash assistance that was in place prior to welfare reform; and most seniors and persons with disabilities who receive cash assistance through the Supplemental Security Income (SSI) program. States may also receive federal Medicaid funds for the costs of covering additional, ‘optional’ populations, including: pregnant women, children, and parents with income above ‘mandatory’ coverage income limits; seniors and persons with disabilities with income below the poverty line; and ‘medically needy’ people — those whose income exceeds the state’s regular Medicaid eligibility limit but who have high medical expenses (such as for nursing home care) that reduce their disposable income below the eligibility limit.” [Center on Budget and Policy Priorities, 5/8/13]