This post originally appeared at Show Me Progress and is part of a series Tammy Booth is writing as a blogging fellow for the Strengthen Social Security Campaign, a coalition of more than 270 national and state organizations dedicated to preserving and strengthening Social Security.
The budget proposal put forth by Paul Ryan is a vicious and cruel all-out attack on everyone under the age of 55, but the cuts to Medicare and Medicaid that the Ryan plan propose would be felt in a particularly acute way by women, who make up more than half of the beneficiaries of both programs, and women retire closer to the poverty line than men do. Women who are alone, who either never married or who are divorced or widowed and never remarried are particularly vulnerable.
The attack on Medicare is one that rallies everyone. Not everyone over 55 is a psychopath who couldn't care less so long as they get theirs. I honestly think that Paul Ryan was counting on people over 55, the largest republican voting bloc out there, not giving a damn so long as they got to keep theirs. I think he is so steeped in Randianism that he was actually taken aback by the pushback he got from people who actually care about their kids and their younger siblings and everyone else who paid in all their adult lives and stand to get rogered roundly if Ryan's scheme sees the light of day.
The CBO, the non-partisan number-crunching office of Congress, estimates that the Ryan scheme would double the out-of-pocket healthcare expenses of seniors. The estimated annual cost of $12,000 for medical coverage would leave grandma eating catfood in the homeless shelter. On average, female seniors have an annual income of only $14,000. Of that annual income, about $12,000 comes from Social Security. (Could you live on $2000 per year?)
Here is the bottom line: Ryan's plan would amount to transferring the entire monthly Social Security benefit for female seniors to private health insurance companies.
I can't possibly sum it up any more succinctly than Senator Barbara Boxer did when she said "This is a sick proposal," during a press conference with other Senate Democrats last week.
As bad as that is, the assault on Medicaid is even worse. Women comprise about 70% of all Medicaid beneficiaries, and while Medicaid has been demonized and branded as welfare, as "free" healthcare for "those people." The right-wing social conservatives have been very successful in projecting the face of Medicaid as an inner city "welfare mother" with several children, presumably with different fathers. That is the implication, anyway, when GOP politicians dismiss Medicaid as a progenitor of promiscuity. But in reality, most Medicaid recipients are elderly people in nursing homes, and idea of making Medicaid a block grant that states could use to deliver healthcare as they saw fit would only make matters worse. States have already mucked up their end of the joint federal-state program, and block grants would make matters far worse.
The CBO estimates that Republicans' proposed plan to block-grant Medicaid would reduce federal program expenditures by 35 percent by 2022 and by 49 percent in 2030 relative to current law. In return, states would have greater flexibility to restructure Medicaid benefits.
How governors would actually use this flexibility is another matter. Medicaid is flexible right now. The Center on Budget and Policy Priorities reports that about 60 percent of state Medicaid spending consists of expenditures to cover people or to reimburse services that are not required under federal law.
Given Medicaid's low per-person cost and its relatively restrained projected cost growth, there's little room to comfortably cut. Safety-net services are already shoestring operations. Under-funded and stressed, they have many shortcomings. There is no way to meet the above spending reduction targets without shifting costs and risks onto the states, covering markedly fewer people and services, or further underpaying Medicaid providers.
No one can firmly say how states would respond to the reduced federal support. I fear that's precisely the point. Block grants provide both states and the federal government with useful political cover to cut important benefits. If a particular state eliminates Medicaid home care services or by dropping the working poor from coverage, Congressional Republicans can say: "Don't blame us. That's what this state chose to do." Meanwhile governors can say, with equal justification: "Don't blame us. We're doing the best we can, given limited federal resources."
I wonder who the care of those elderly and disabled people would fall to if Medicaid went away?
I can tell you who it would fall to -- it would fall to women, mostly in their forties and fifties, women would have to leave the workplace to care for their elderly parents or disabled siblings or children, high-need individuals whose nursing home care would no longer be paid for.
This in turn would reduce the amount of benefit those women would be eligible for upon retirement, thereby assuring the transfer of every single penny of the retirement benefits women worked all their adult lives for, to private companies.
And so it goes.
Yes, there is a war on women, and it isn't just being waged against those in their childbearing years.
They really are out to get us all. And no, I'm not paranoid. It's only paranoia when the threat is imaginary, and this one is not; it is quite real.