"Innovate"

So, the Ryan budget, passed by those brave deficit hawks in the House, is going to take a huge bite out of Medicaid by

changing the program from an open-ended program for eligible individuals using matching funds from both the federal and state governments to a block grant of a fixed sum given to states, and the states decide how to allocate the money. The idea is that states can “innovate” at a local level to find ways to deliver needed benefits at reduced cost.

This will save $750 billion over the next decade. Yay!.. Um, wait, yay?

This notion that the states can always do it better than the federal government (as long as "it" isn't, say, medical marijuana or gay marriage or gun control) really comes unglued when it comes to anything that applies to huge numbers of people.

Specifically, here, that "find[ing] ways to deliver needed benefits at reduced cost". Pretty much all any state can do to reduce the cost while staying inside their (reduced) block grant is either cut payments to doctors and hospitals - a lot, drop people from the rolls, or cut benefit payments. The first option is problematic for two reasons: doctors and hospitals already think Medicaid doesn't pay enough; a lot of doctors won't even accept Medicaid patients. Secondly, Medicaid does cost less than private insurance; that's one way ACA was keeping costs down: expanding Medicaid eligibility. So there's less to cut.

The other two options involve cutting benefits - that is, giving people less help - or eligibility - that is, helping fewer people. Nice choice, there, House Republicans.

Because the fact is (as Aaron Carroll, MD, MS, points out over at the JAMA website) Medicaid doesn't cover your "able-bodied people", lulling them "to lives of dependency and complacency" as the architect of this plan so winningly puts it. Medicaid basically covers four groups of people: the blind and disabled, the elderly, children and pregnant women (they're the same thing per the GOP, right?), and poor parents of children. And I mean poor: in Texas, if you earn $5000 a year - a year - you earn too much to qualify.

So this "innovation" really means abandoning people who have no other means of survival.

By their God, Republicans love them some fetuses but don't much give a rat's ass for anyone already here, do they? Not unless that anyone is rich, anyway.