In his acceptance speech at the 2012 Democratic National Convention, President Obama stated clearly and concisely, “And I will never turn Medicare into a voucher.”  But what about Medicaid?

Developments in Arkansas, Ohio, and Florida provide evidence that the Obama administration’s hard stance against vouchers in Medicare doesn’t extend to Medicaid.  Christine Vestal at Stateline reported on Friday that the federal government appears likely to sign off on Ohio and Arkansas’ plan to place those persons made eligible for Medicaid by Obamacare (persons between 100-138% of poverty level) into health exchanges to buy private insurance.  (You can read my previous posts on that topic here and here, as well as other informative writing on Medicaid expansion here and here.)

Health News Florida also reports that the Obama administration signaled its receptiveness to Florida’s similar plan for Medicaid premium support.  (Read more on Florida here.)

The contrast between the Obama administration’s hard stance against Medicare vouchers and its demonstrated openness to offering vouchers for a portion of the Medicaid population provides an interesting window into the different politics of Medicare and Medicaid.  This episode illustrates why supporters of Medicare fight so hard against means-testing, for it is the health insurance program for the poor that seems more vulnerable to retrenchment than its companion program for the elderly.  This seems to validate the fear that if Medicare was fragmented by income group, it too would become vulnerable to cuts or reorganization.

The history of American social policy is dotted with examples of social policies that are perceived to disproportionately benefit the “undeserving” struggle for political support and stability. (For a fantastic read on this topic, see Theda Skocpol’s Protection Soldiers and Mothers, Harvard 1992.  In it, we see how the United States was a leader in providing social insurance among advanced industrial countries, but did so only for the “deserving,” women, children, veterans, and the elderly.)

Just think back to the rhetoric and energy that was prevalent in the discussions surrounding the Ryan Budget’s Medicare premium support/voucher proposal.  In the articles and discussion of the Arkansas/Ohio/Florida Medicaid expansion strategy, you would be hard pressed to see or hear anyone using the words premium support, let alone vouchers.  The contrasting level of political organization and reaction to introducing vouchers in these two programs is quite interesting – and a little sad.

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