The CBO analysis concludes about these block grants that these proposed cuts would "likely force states to scale back their Medicaid programs considerably." Since poor people, seniors, and people with disabilities make up the majority of those who receive Medicaid, "they'd be hit the hardest."
4. Romney's accusation that Obama cut Medicare by $716 billion is misleading.
In the debate, Romney said 10 times that Obama was paying for his health care package by taking the money from Medicare recipients' pockets, cutting $716 billion out of the program.
"To balance the additional cost of Obamacare is, in my opinion, a mistake," Romney said. In his closing statement, he promised to restore that amount.
Dozens of bipartisan fact-checkers say that number, often repeated by the Romney/Ryan campaign, is misleading.
Where does it come from? It's the figure mentioned in a letter from the Congressional Budget Office sent to House Speaker John Boehner in July. Boehner had asked for an analysis from the CBO if Congress could repeal Obamacare, something Romney said he would do if elected. "Spending for Medicare would increase by an estimated $716 billion" over the next decade, the analysis said.
That means Medicare would cost the government more. Obama's health legislation does not mean people will see cuts to their benefits. Hospitals and health care providers will, but that's what they agreed to in exchange for the Affordable Care Act's mandate that people have health insurance. If more people have health insurance, hospitals will have to care for fewer of the uninsured. Uninsured patients cost significantly more to care for than patients who are insured.
It is unclear what impact the cuts would have on the Medicare program. Romney argues providers will accept fewer Medicaid patients. In the debate he said, "Some 15% of hospitals and nursing homes say they won't take any more Medicare patients under that scenario (Obamacare)."
Medicare's own independent actuary, which it uses to analyze changes in the program, has warned that these planned cuts to pay providers' bills will force some doctors to stop accepting Medicare patients.
5. The Cleveland and Mayo Clinics do it better.
The candidates agreed during the debate that more needs to be done to control the cost of health care.
Obama praised the Cleveland Clinic as a model for new ways of controlling the cost of care. "They actually provide great care cheaper than average," he said. "And the reason they do is because they do some smart things."
One approach he highlighted was the collaborative approach of the clinic's doctors. Instead of each doctor ordering a different test, they meet and decide as a team how to approach the patient's problem. They also provide preventive care.
Obama has held the clinic up as a model throughout his time in office. He visited it in 2009. It is a top-ranked teaching hospital that attracts patients from around the world. An analysis done by the Dartmouth Atlas of Health Care found that the Cleveland Clinic did treat Medicare patients for tens of thousands of dollars less than many other medical centers.
One of the big differences between the Cleveland Clinic and other hospitals is that it and other multi-specialty clinics like the Mayo Clinic in Minnesota employ their own doctors and can create these teams. In most traditional hospitals, doctors are independent private practitioners who are left to making their own choices.
Because Cleveland Clinic's doctors are paid fixed salaries, there is less incentive to order unnecessary tests or procedures compared to a doctor working on his or her own who receives a bump in their fee.
As of right now, Medicare acts a lot like those traditional hospitals do, Thorpe said. "If you take the typical patient who is chronically ill, they will be overweight or obese, they suffer from bad cholesterol, hypertension, asthma and diabetes -- that means they take 10 to 15 medications and there is no team-based care," he said.
"Going to separate doctors with their own plans is expensive. These integrated group plans work well and the ongoing preventive care they provide -- working with doctors, nutritionists, nurses, nurse practitioners and the rest -- ultimately save on costs."