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Making Medicaid matter

<p>&lt;p&gt;Much of the 2012 policy debate, such as it is, has focused on Medicare, and with good reason -- the Romney-Ryan plan to replace the Medicare system

Much of the 2012 policy debate, such as it is, has focused on Medicare, and with good reason -- the Romney-Ryan plan to replace the Medicare system with a voucher plan is important and worth scrutinizing in detail.

But in his convention speech last night, Bill Clinton not only stressed Medicare, he also delivered a forceful reminder about the importance of Medicaid and what would happen to the program under Republican rule.

"Now, folks, this is serious, because it gets worse. And you won't be laughing when I finish telling you this: they also want to block-grant Medicaid, and cut it by a third over the coming 10 years."Of course, that's going to really hurt a lot of poor kids. But that's not all. A lot of folks don't know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid."It's going to end [Medicaid] as we know it. And a lot of that money is also spent to help people with disabilities, including a lot of middle-class families whose kids have Down's Syndrome or autism or other severe conditions.And honestly, let's think about it, if that happens, I don't know what those families are going to do. So I know what I'm going to do. I'm going to do everything I can to see that it doesn't happen. We can't let it happen."

The future of Medicare is obviously important and should be a central issue in the presidential race, but as Matt Yglesias noted, "Medicaid is the one where much more is at stake on the ballot."

Why? Because the Romney-Ryan plan, with a position they're not at all bashful about, would block-grant Medicaid, leaving states with fewer resources, and leaving the poor and disabled in even more jeopardy.

Remember, unlike Medicare, Medicaid is a partnership between federal and state governments. The program undermines state budgets in a big way during economic downturns -- more people begin to rely on the program and states, which can't run deficits, struggle badly with the finances -- and the moment a Romney-Ryan administration gives states the flexibility to do so, Republicans governors will start improving their finances by taking health care from the most vulnerable, who don't exactly have lobbyists looking out for them.

What's more, as Clinton reminded us, for all of Romney's talk about leaving seniors' benefits intact, the moment the GOP guts Medicaid, plenty of elderly Americans will feel the effects.

There's no shortage of policy differences between the two major-party campaigns, but this is one of the more dramatic areas of disagreement, especially as it relates to the real-world impact of struggling Americans. Medicaid deserves to be an important part of the national debate, and kudos to Clinton for giving the issue the spotlight.