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Before Mitt Romney brought Congressman Paul Ryan onto the Republican ticket, Ryan was already a rising star in conservative circles. He made a name for himself a couple of years ago when he unveiled a budget proposal that would turn Medicare into a voucher-like system. In a few minutes, we'll look at some of the defining moments in Ryan's personal life. First, this look at another aspect of health care that will likely get some time in the spotlight during this campaign. That's Medicaid, the program for the poor. Here's NPR's Julie Rovner.
JULIE ROVNER, BYLINE: Medicaid is actually the nation's largest health insurance program, covering some 60 million Americans with very limited incomes. But you'd be excused for not knowing that, because Medicaid doesn't get that much attention, particularly compared to its more politically powerful partner, Medicare.
That may be changing. The Supreme Court earlier this summer put the program in the news when it ruled that the Medicaid expansion in the 2010 health law must be optional for states. That's given more ammunition to Republicans, including presidential candidate Romney, who want to offer states far more responsibility for Medicaid. Here's Romney describing his health plan in 2011.
MITT ROMNEY: The state is the best place to determine what's the best way to help those poor. And so I would therefore block grant to the states' Medicaid funds, and say states you now use these moneys as you feel appropriate to care for your own poor.
ROVNER: Only there's a catch, said President Obama in a speech earlier this spring. Under the plan devised by vice presidential pick Paul Ryan and passed by the House, Medicaid funding would not only be turned back to the states, it would be cut substantially.
PRESIDENT BARACK OBAMA: They would have to be running these programs in the face of the largest cut to Medicaid that has ever been proposed, a cut that according to one nonpartisan group would take away health care from about 19 million Americans.
ROVNER: Now, that doesn't seem to bother a lot of Republicans, particularly those on Capitol Hill. That's because they don't think Medicaid works very well. Tim Huelskamp is a Republican congressman from Kansas. He spoke at a news conference last month in support of a House bill that would implement Ryan's plan. It would transform Medicaid from its current status as an unlimited entitlement program whose costs are shared between the federal and state governments to a limited block grant to each state.
REPRESENTATIVE TIM HUELSKAMP: Medicaid is breaking the bank and it's actually probably the worst care system that we have in the entire country.
ROVNER: Huelskamp and others who make that claim cite a series of studies. They've shown that people with Medicaid coverage do worse than people with other insurance coverage or people with no coverage at all. But Medicaid researchers say those studies don't portray Medicaid accurately.
Katherine Baicker is a professor at the Harvard School of Public Health and a former economic advisor to President George W. Bush. She says a lot of the studies haven't been able to control for the fact that people who get Medicaid tend to be in worse health than people who don't.
KATHERINE BAICKER: It's not that Medicaid is causing the health outcomes to be bad, it's that people with more health needs - or potentially more serious health conditions - are the ones who more likely successfully sign up for Medicaid.
ROVNER: But now that's changing. Last year, Baicker was part of a unique study that took place in Oregon. That state held a lottery for low income adults to see who gained Medicaid coverage and who didn't. That gave researchers a chance to make apples to apples comparisons on how Medicaid actually affects enrollees' health. Its findings? Almost uniformly positive.
BAICKER: We found that gaining access to Medicaid increased healthcare use, and that was preventive care, doctor's office visits, but also hospitalizations. It dramatically reduced financial strain, such as lowering the likelihood of having a bad debt sent to collection by 25 percent.
ROVNER: People who got Medicaid were also more likely to report being in better health as a result. Baicker is also co-author of a study out just last month in the New England Journal of Medicine. It compared three states that expanded Medicaid to low income adults to three neighboring states that didn't. It wasn't as scientifically rigorous as the Oregon study, but it had a much larger study group.
BAICKER: And we found, in fact, that states that expanded Medicaid to that group of adults relative to states that didn't had substantially lower mortality.
ROVNER: Meaning people who got Medicaid coverage were less likely to die than people who didn't. This study couldn't tell if Medicaid was the reason. But it refutes other studies suggesting that Medicaid is bad for people's overall health. And it's likely to serve as still more fodder as the political debate over Medicaid heats up this fall.
Julie Rovner, NPR News, Washington.
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