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Ryan budget would hurt poor and elderly, critics say

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If enacted, Ryan’s budget would dramatically reshape Medicaid, the state- and federally funded health plan for the poor. As enrollment swells with jobless adults and their families who lost health care, Medicaid has become a huge drain on state finances, and many governors have called for the very fixes the Ryan plan incorporates.

Rather than paying a fixed share of total Medicaid spending, Ryan’s plan gives states capped amounts of federal money, or block grants, to operate and restructure their Medicaid programs with little federal oversight. With the added flexibility, many state leaders envision greater program efficiency and less waste.

If federal grants don’t keep pace with rising medical costs and enrollment increases during economic downturns, states could end up with less federal funding over time. Federal Medicaid spending would likely drop by $810 billion — roughly 22 percent — from 2013 to 2022 under Ryan’s plan.

Funding in 2022 alone would be more than a third less under Ryan’s budget than states would get under the current funding formula, the Center on Budget and Policy Priorities estimates.

This shortfall would force states — most of which are already cash-strapped — to either pay a larger share of Medicaid program costs or to cut services.

According to a report by the nonpartisan Congressional Budget Office, “Cutbacks might involve reduced eligibility … coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries — all of which would reduce access to care.”

Those cuts and the Ryan plan’s calls to repeal the Affordable Care Act — the landmark health care law passed in 2010 — would add tens of millions of low-income Americans to the ranks of the uninsured. It also would raise taxpayers’ bill for emergency room indigent care and cause an increase in private insurance rates.

Over the next decade, Ryan’s plan would also turn the food stamp program, now known as the Supplemental Nutrition Assistance Program, into block grants. According to the Center for Budget and Policy Priorities, that would mean a $133.5 billion, or 17 percent, reduction in funding. The program currently enrolls more than 46 million low-income Americans, mainly families with children, seniors and the disabled.

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