The New York Times (almost) tells us a secret!


That secret involves Medicaid: On Friday morning’s front page, the New York Times (almost) told us a secret.

The secret involved Mitt Romney’s proposed reinvention of Medicaid. The Times tends to describe Medicaid as “the joint state-federal program that provides health care to poor and disabled people” (see below).

What secret did the Times almost disclose? Medicaid isn’t just for poor people any more! A point of personal privilege:

We have been in the Hudson Valley the past few days visiting an 84-year-old friend who is in a nursing home. His bills are paid by Medicaid.

He lived his life as a middle-class person. His wife and his son are still middle-class people. Last Friday, as we boarded a train for our trip to this region, Nina Bernstein was spilling such beans on the front page of the Times:
BERNSTEIN (9/7/12): Medicaid has long conjured up images of inner-city clinics jammed with poor families. Its far less-visible role is as the only safety net for millions of middle-class people whose needs for long-term care, at home or in a nursing home, outlast their resources.

With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance. So while Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes—those proposed, and others already under way.

Though former President Bill Clinton overstated in his convention speech on Wednesday how much Medicaid spends on the elderly in nursing homes—they account for well under a third, not nearly two-thirds, of spending—Medicaid spends more than five times as much on each senior in long-term care as it does on each poor child, and even more per person on the disabled in long-term care.
We haven’t been able to fact-check Bernstein’s fact-check of Clinton. (None of the three major fact-check sites have checked that particular statistic.)

But let’s assume Bernstein’s statistics are right. Later, she writes that “31.5 percent of Medicaid’s $400 billion in shared federal and state spending goes to long-term care for the elderly and the disabled,” although she doesn’t say how many such people are middle-class.

Whatever! At any rate, Candidate Romney has proposed massive changes to Medicaid, including massive reductions in Medicaid spending. Presumably, this would have a massive effect on all kinds of people receiving nursing home care, including all kinds of middle-class people with middle-class spouses and children.

We’ll guess that very few voters understand the potential effect of Romney’s proposal on middle-class people. This topic is very rarely discussed—in the New York Times, for instance.

Two recent examples:

Last Friday, Bernstein explained the fact that Medicaid pays for the nursing home care of middle-class seniors. But she seemed to bend over backwards to avoid discussing Romney’s proposal.

Remarkably, Romney’s name was never mentioned in the Bernstein piece. Bernstein restricted herself to a brief discussion of what might happen “if Republicans carry out their plan to replace Medicaid with block grants that cut spending by a third over a decade.”

Readers weren’t told that “Republicans” pretty much means “Mitt Romney.” When it comes to matters like this, the Times tends to be very cautious.

Second example:

On September 1, Abby Goodnough did a much shorter report, inside the paper, about the Medicaid proposals of the two campaigns.

In this case, Goodnough described the severity of Romney’s proposed cutback in funding. (Headline: “2 Campaigns Differ Sharply on Medicaid, Seeking Vast Growth or Vast Cuts.”) But a reader had to read with great care to see that Romney’s proposed cutbacks would (presumably) affect a great many middle-class families.

Is Medicaid for the middle class too? As her report began, Goodnough distinguished Medicaid from Medicare in standard fashion:
GOODNOUGH (9/1/12): The way Mitt Romney and Representative Paul D. Ryan frame it, the debate over social programs that has become a dominant theme of the presidential race is all about the future of Medicare, the government health insurance program for retirees.

But the outcome of the election will probably have a more immediate and profound effect on Medicaid, the joint state-federal program that provides health care to poor and disabled people.

Few other issues present a starker difference between the Republican and Democratic tickets.


In pure dollar terms, the difference comes down to this: As chairman of the House Budget Committee, Mr. Ryan has proposed cutting federal spending on Medicaid by $810 billion over 10 years. Mr. Obama's expansion plan, by contrast, would cost an additional $642 billion over the same period, according to the most recent estimate from the Congressional Budget Office.
Those are large changes in spending. Goodnough had already established that Medicaid "costs the states and the federal government more than $400 billion a year."

Goodnough describes the enormous differences in the two campaigns' proposals. But forget what you learned from last Friday’s report! According to Goodnough’s opening presentation, Medicare is “for retirees.” By way of contrast, Medicaid “provides health care to poor and disabled people.”

As she continued, Goodnough quickly noted that the Affordable Care Act (Obamacare) would allow “everyone with incomes up to 133 percent of the poverty level to enroll.”

Medicare serves retirees; Medicaid serves the poor. Only one tiny sentence midway through her report gave readers a hint about all those other Medicaid recipients, the ones from middle-class families:
GOODNOUGH: For all the allegations and counterallegations about Medicare on the campaign trail, hardly any words have been uttered about Medicaid, probably because the elderly are considered a more engaged and influential voting group than the poor. But what happens to Medicaid will have a significant effect on many middle-class older people who rely on the program for nursing home care. More than half of current Medicaid spending is on the elderly and the disabled. About half of Medicaid recipients are children; an additional 25 percent are elderly or disabled people.
Please note: Even as Goodnough mentioned those “many middle-class older people who rely on [Medicaid] for nursing home care,” she was reinforcing the notion that Medicare is for “the elderly” while Medicaid is for “the poor.” And this paragraph represented her only attempt to explain that those large proposed spending changes would affect many middle-class families.

Medicare serves retirees; Medicaid serves the poor. Until Bernstein’s report appeared, this framing dominated the New York Times’ coverage of these two programs. And doggone it! Last Friday, Bernstein stressed the fact that many middle-class people are Medicaid recipients. But as she did, she seemed to go out of her way to avoid discussing Romney’s “vast cuts” to Medicaid, the vast cuts which appeared in Goodnough’s headline.

How many voters understand how Romney’s Medicaid proposals would affect middle-class families? We will guess that very few voters have anhy such understanding. We can’t say that we’ve ever encountered such a discussion in the nation’s press.

But then, America’s mainstream press corps is an ongoing study in Potemkinism. In the case of the New York Times, subscribers get the impression that they’re being informed about major issues.

In one major topic after another, the reality is quite different.

Presumably, Romney’s Medicaid proposal would mean that many middle-class seniors with large disabilities would be on the way from nursing homes to the ill-equipped homes of their middle-class children and spouses.

Or something. Whatever!

We say “presumably” for a good reason—we say that because we read the Times! We have never seen a report in the Times of the way the Romney proposals would affect middle-class Medicaid recipients.

Here, as in so many areas, Gotham’s greatest pseudo-newspaper seems disinclined to discuss or disclose.

A tale of two news reports:

Goodnough, 9/1/12: 848 words, page A12. Notes the severity of Romney and Ryan’s proposed cuts to Medicaid. But barely mentions the large number of middle-class recipients who would presumably be affected.

Bernstein, 9/7/12: 1565 words, page A1. Stresses the large number of middle-class people who receive care under Medicaid. But fails to mention the Romney and Ryan proposals.


  1. Medicare also serves certain groups of disabled people. Nearly everyone in the country is a self-proclaimed expert on the various public benefits programs. Nearly everyone is wrong.

  2. I actually don't mind that Bernstein did not mention Romney. To me, the national discourse is too much about Prexy, Prexy, Prexy (as John Brunner calls the President). Right now polls show that the American public will re-elect Obama AND also re-elect most of the Republican (and Democratic) House. We need MORE discussion about what Republicans in Congress are doing, not less. It's not all about Romney-Ryan-Obama-Biden.

  3. Anonymous above makes an important point. But still, thank you for helping to disentangle (as a NYT daily reader I do declare, what a tangle!) the NYT coverage of the most basic and essential is!

  4. To clarify - Medicaid does NOT cover middle-class people with assets. One has to "spend down" to qualify - it is a means-tested program, one has to have on paper proof that one qualifies as low-income. The problem is that many middle-class and upper-class people that could afford to pay out-of-pocket hire attorneys that find loop holes to hide their assets - this is called "Medicaid planning." Although loopholes have been closed in recent years, for the saavy there are still ways to "spend down" on paper. Otherwise, for the vast majority of middle-income and middle-class Americans, we do in fact spend all of our life's savings until we qualify for Medicaid status, at which point, we become "poor." With nursing homes an average of $90,000 a year, and Medicare not covering most nursing home care, it does not take long to become poor in a nursing home.