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Paul Ryan has become the gift that keeps on giving. Unfortunately his ideas are very destructive to the welfare of American lives so that the rich can get richer and that’s never a good thing. Simon Lazarus did some good work exposing the important fact that Ryan’s plan indeed consists of an individual mandate, which is exactly what Republicans have been campaigning against. The Ryan budget would reshape Americans’ access to health insurance mainly through two provisions, both of which pressure people to purchase private health insurance to an extent and through mechanisms that are materially indistinguishable from the supposedly toxic Obamacare mandate. One of these Ryan budget proposals — as yet little noticed by pundits or politicians — is almost an exact copy of its equivalent in the Affordable Care Act. Igor Volsky catches Paul Ryan admitting to that important fact at one of his town halls in Racine: Some conservatives have tried to defend Ryan’s plan from the comparison, but it turns out that the congressman agrees with it. During a town hall in Racine, Wisconsin on Friday, Ryan — who has previously opposed the measure — admitted that his plan includes a mandate: Q: If Medicare becomes a voucher program, would you require seniors to purchase private insurance and if so isn’t that an individual mandate? If you will not require them to purchase insurance how do you propose to prevent a situation where the costs of uninsured seniors is very expensive and gets passed on to me as a private policy holder? RYAN: Its mandate works no different than how the current Medicare law works today, which is you just select from a wide range of different plans . It literally would be like Medicare Advantage… Instead of keeping up a lie, Ryan was forced to concede on this matter. I’m sick and tired of Ryan telling us that everybody over fifty five won’t be affected under his new plan. All that is is a way to try and keep seniors that are currently in the program from turning against him, but we have generation after generation of Americans that eventually will have to fit neatly into Ryan’s scam of a plan and we will have our lives irrevocably destroyed by his Randian ideas for seniors. Gov. Scott Walker tried to scam the police and fire fighters in Wisconsin when he excluded their unions from losing their collective bargaining rights in his draconian bill, but they were courageous enough not to be sucked into his trap. However, Medicaid is in real danger now as Ezra Klein outlines: There are two reasons Medicaid is more vulnerable than Medicare. The first is who it serves. Medicaid goes to two groups of people: the poor and the disabled. Most of the program’s enrollees are kids from poor families, though most of the program’s money is spent on the small fraction of beneficiaries who are disabled and/or elderly. These groups have one thing in common, however: They’re politically powerless. The second is who pays. Medicare is a federal program. Medicaid is a state-federal match, and it kills states during recessions, as unlike the federal government, states can’t run deficits, and so they find themselves with increased costs because they have more people in need but decreased revenues. So there are a lot of governors — particularly GOP governors — straining under overstretched state budgets who’d like a way out of their fiscal crisis that doesn’t include raising taxes, and there are a lot of federal legislators who’d like to save money without having seniors mounting protest marches outside their office, and Medicaid begins to look like an answer to everyone’s problem. “You can shift costs to states so they can be the bad guys while the federal policymakers pretend they didn’t hurt anybody,” says Bob Greenstein, president of the Center on Budget and Policy Priorities. Digby: Mandates and Medicaid I don’t know how this affects the mechanism to expand Medicaid under Health Care Reform but even under the best case scenario (that the dollars are already mandated under the bill and the president refuses to sign anything that changes that), if these cuts go through, it’s robbing Peter to pay Paul. Certainly, any cuts that are happening in 2012 will create a worse starting point for the level of expansion envisioned for 2014 and beyond. This was always my gut feeling about the health care reform bill and I wrote about it incessantly during the endless debate . I believed it could improve the private insurance market for some members of the middle class who are self-employed and that there was some potential for cost savings down the road. But the only truly liberal vision contained within it — bringing more poor people under Medicaid — would fall apart once the deficit hawks who were already circling swooped in. (Remember Ben Nelson’s Medicaid “opt-in” proposal?) This was the bait they used to trap progressives and I understood exactly why they couldn’t get out of it. It’s very hard to walk away from something that might benefit millions and millions of poor people. But it was always the weakest link and it’s just sad to see it all playing out so predictably. What I do know is that the poor and disabled are always at the forefront of the chopping block whenever ‘ budget cuts” are the talk of the town and for the great country that we live in, it’s a complete travesty. Where’s that American exceptionalism from the Bill O’Reilly’s when you really need it?