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When Medicaid is 'the only choice'

<p>Medicare is a key issue in the 2012 election, up and down the ballot, and it deserves to be.</p>

Medicare is a key issue in the 2012 election, up and down the ballot, and it deserves to be. The Republican plan to end the Medicare system and replace it with a privatized voucher scheme for future retirees is critically important.

But as we've talked about for months, it's Medicaid that too often gets lost in the shuffle, which is to the public's detriment -- the differences between the parties on this issue are among the critical of 2012. Indeed, the Obama campaign launched this new ad on Medicaid overnight.

For those who can't watch clips online, here's the transcript of the 30-second spot:

"It's one of the hardest decisions a family can make -- realizing a nursing home is the only choice. For many middle class families, Medicaid is the only way to afford the care. But as a governor, Mitt Romney raised nursing home fees eight times. And as president, his budget cuts Medicaid by one-third and burdens families with the cost of nursing home care. We have a president who won't let that happen."

The ad, titled "Only Choice," will be aired in the eight key battleground states: New Hampshire, Virginia, North Carolina, Florida, Ohio, Iowa, Colorado, and Nevada.

As a stylistic matter, I suspect an ad like this is intended, in a not-so-subtle way, to make Romney appear callous and indifferent to the need of seniors and struggling families. If last week's debate helped erase fears about Romney's elitist attitudes -- fears reinforced by the infamous "47 percent" video -- an ad like this is intended to help remind voters about what they didn't like about Romney in the first place.

But let's also not forget the substance, and the extent to which President Obama and Romney offer dramatically different approaches to this critical health care lifeline.

To reiterate a point we discussed last month, Romney and Paul Ryan are not at all bashful about their plan to 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.

Obama made the case on this during last week's debate:

"As I indicated before, when you talk about shifting Medicaid to states, we're talking about potentially a 30 percent cut in Medicaid over time. Now, you know, that may not seem like a big deal when it just is, you know, numbers on a sheet of paper, but if we're talking about a family who's got an autistic kid and is depending on that Medicaid, that's a big problem. And governors are creative. There's no doubt about it. But they're not creative enough to make up for 30 percent of revenue on something like Medicaid. What ends up happening is some people end up not getting help."

There's no shortage of policy differences between the two major-party campaigns, but this is one of the more important 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 this ad is a step in the right direction.