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The Candidates and Medicaid

Purely from a policy standpoint, today was a terrible day to be "against" Medicaid. For the first time, reported The New York Times, a large-scale study of the impact of Medicaid found that

When poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability. . . .

In short, people who assert that Medicaid doesn't actually help beneficiaries -- including wonks such as Avik Roy and Scott Gottlieb -- are wrong.

The results of the study also come at an inopportune time for the White House, which appears to be using the venerable program as a bargaining chip in the debt ceiling negotiations. For the Democratic Party, the decision to expose Medicaid to such a degree sets a precedent. (President Bill Clinton arguably weakened Medicaid, but also vetoed an attempt at transforming it into a block grant.) For Republicans, and the candidates in particular, this is Christmas in July.

Mitt Romney advocates block grants for Medicaid, a position straight out of Paul Ryan's budget plan. Republicans, including Ronald Reagan in 1981, Newt Gingrich in 1995 and President George W. Bush in 2003, have tried and failed to enact block grants. In part, this is owed to the damage such a move would inevitably do to the states: the hole in the respective balance sheets would be massive. As Deval Patrick recently observed, "Massachusetts would lose more than $23 billion over 10 years if Medicaid moved to block grant form. There’s no way our Commonwealth with a balance sheet even as strong as ours would able to absorb such a cost shift."

Michele Bachmann, too, is no supporter of Medicaid, claiming the expansion of the program undre the new healthcare law will the "welfare rolls." This position, which deviates not much from conservative orthodoxy, has caused her short-term grief ever since Michael Isikoff reported that the Congresswoman and her husband received $137,000 in state Medicaid payments. Of interest, Bachmann -- if for only a moment -- had some nice things to say about Medicaid. Shortly after her election to the House (January 2007),  she released a statement congratulating Fairview Northland Regional Hospital on being named one of the top performers in a Centers for Medicare and Medicaid Services (CMS) pay-for-performance project, "reward[ing] hospitals for delivering higher quality care in five clinical areas." Among its many functions, the CMS works with state governments to administer Medicaid.

Tim Pawlenty has all but jettisoned his past support for the program. As recently as 2006, he championed an expansion of Minnesota's Medicaid program, which would have covered the working poor and children. By September of 2010, however, Pawlenty boasted that, were he to run for President, it would be on a platform promising the opposite -- a repeal of Obama's healthcare reform. To prove this wasn't mere rhetoric, Pawlenty proceeded to delay Minnesota's long-planned expansion of Medicaid, costing the state millions. (Medicaid and Medicare recipients are, of course, bearing the brunt of Minnesota's ongoing government shutdown.) Gov. Mark Dayton has since reversed the decision.

John Huntsman was positive about Medicaid in his days as Utah Governor, but those days may be over. In 2008, Huntsman sought to protect Medicaid from budget cuts by the state legislature saying that it didn't make sense to reduce access to medical care when one in four Utah residents was insured. "Critical human service programs are being preserved wherever possible. Some reductions are necessary, but even in difficult budgetary conditions, we must protect the most vulnerable among us." More recently, though, Huntsman has endorsed Paul Ryan's draconian budget which envisions blockgranting and making major cuts to Medicaid.