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Impacts of the Proposed Restructuring of Medicare and Medicaid on the Elderly: A Conceptual Framework and Analysis

The article examines the proposed transformations in U.S. Medicare and Medicaid as these are likely to affect the nation's elderly population. Drawing on political economy, moral economy, and notions of the deserving versus the undeserving poor, the authors develop a broad conceptual framework within which to better understand the current upheavals. Both Republican and Democratic proposals for restructuring Medicare and Medicaid are described and analyzed, and common themes within the various proposals highlighted. After exploring the differential impacts of the restructuring on subgroups within the elderly population, including low-income seniors, the disabled, women, and elders of color, the authors conclude with a discussion of the symbolic importance of the proposed transformations. The latter reflect both accelerated government movement away from its legitimation functions and toward increased capital accumulation, and continuing government attempts to reshape our perceptions of the state economy in ways that permit more radical cutbacks and austerity measures.