The Democratic plan would cut as much as $500 billion from Medicare, Medicaid and other health programs and would raise taxes by $1.3 trillion; the proposal also would include $300 billion in stimulative measures. Boehner on Thursday criticized the $1.3 trillion figure for new taxes as too high and the $500 billion in health care savings as too low. "When you look at the Medicaid number that I've read about, some $50 billion worth of changes—let's understand, over the next 10 years we're going to $10 trillion on Medicaid," he said. "I just think there's a lot more room there to help find common ground."

House Speaker John Boehner, representing his caucus, wants to gut Medicaid

He apparently isn't aware of the fact, reflected in that graphic from the Center on Budget and Policy Priorities, that Medicaid is a really cost effective way of providing health care. When he refuses to acknowledge that, you know he's ignoring the other realities of Medicaid, like those reported in the Kaiser Family Foundation's 50-state survey of the program. Like this one: "Faced with the end of stimulus money and a continuing weak economy, Medicaid officials in virtually every state are enacting a variety of cost cutting measures as states’ spending for Medicaid is projected to increase 28.7 percent this fiscal year to make up for the loss of federal funds."

"Unemployment remains high with increasing numbers of poor and uninsured keeping pressure on state budgets and Medicaid programs to meet growing needs," said Diane Rowland, Executive Vice President of the Kaiser Family Foundation and Executive Director of the Foundation’s Commission on Medicaid and the Uninsured. "But the cumulative effect of two recessions since 2001 and a decade of constrained spending has left no cushion and many of the latest cuts will hit at the core of the Medicaid program." The state focus on cutting costs renews a theme seen much of the last decade. It occurs against a backdrop of deficit reduction efforts in Washington that could reduce federal support for Medicaid and shift costs to state capitols at a time when states are coping with historically difficult budget conditions and must also lay the ground work for a significant expansion of Medicaid under the health reform law.

What that means is that states are finding every way possible to reduce costs, including benefit cuts, while the need for the program continues unabated because of the recession.

Due to maintenance of effort requirements included in the ARRA and health reform legislation, states have been prohibited from enacting new restrictions on Medicaid eligibility or enrollment procedures. Instead they have turned to other measures that in some cases build on efforts in play for the last decade, including: Provider rate restrictions. This was the most commonly reported strategy, with 39 states restricting rates in 2011 and 46 reporting plans to do so in 2012. But a number of states also increased or imposed new provider taxes that can generate more federal matching revenue and help mitigate the effects of cuts to some providers.

This was the most commonly reported strategy, with 39 states restricting rates in 2011 and 46 reporting plans to do so in 2012. But a number of states also increased or imposed new provider taxes that can generate more federal matching revenue and help mitigate the effects of cuts to some providers. Benefit reductions and restrictions. States continued to eliminate, restrict or reduce Medicaid benefits in areas such as dental, therapies, medical supplies, durable medical equipment and personal care services. Almost all states have been making substantial changes in Medicaid pharmacy programs, including preferred drugs lists, supplemental rebates and prior authorization requirements and states are now focusing on controlling costs for specialty drugs, a rising share of prescription drug spending.

States continued to eliminate, restrict or reduce Medicaid benefits in areas such as dental, therapies, medical supplies, durable medical equipment and personal care services. Almost all states have been making substantial changes in Medicaid pharmacy programs, including preferred drugs lists, supplemental rebates and prior authorization requirements and states are now focusing on controlling costs for specialty drugs, a rising share of prescription drug spending. New and higher copayments for beneficiaries. Five states in FY 2011 and 14 states in FY 2012 increased copayment amounts or imposed new copayments, compared to only one in FY 2010. Most copayment changes were for pharmacy and emergency room visits, although a few states are requesting federal waivers to implement broader changes that would have

higher amounts and apply to populations traditionally exempt in federal law.

Nearly 60 million low-income Americans have health coverage and long-term care services because of Medicaid. That includes 29 million low-income children, 15 million adults and 15 million elderly and disable people. Add to that the 9 million low-income Medicare beneficiaries who need Medicaid to pay Medicare premiums and cost-sharing and to cover critical benefits that aren't covered by Medicare.

Now, Boehner doesn't particularly care that the states are struggling, that millions of people only have health care because of it, or that cuts to it will result in jobs lost and increased systemic health care costs when people get sicker and require more expensive interventions because they couldn't get preventive primary care under Medicare.