I spent a couple hours yesterday fruitlessly trying to find numbers regarding the actual changes in funding that would come about as a result of Romney's plan to overhaul Medicaid by turning it into a block grant program. Finally found an analysis, from the Center on Budget and Policy Priorities, of a similar plan, one by Paul Ryan which has a slightly different but similar formula to determine funding.
To summarize the analysis, had the policy been put into place in 2000, total federal Medicaid funding, which accounts for up to 80% of all Medicaid funding for a state, would have fallen by 29% in 2009. Were the policy put in place in 2013, it would result in a 49% cut in funding by 2030. By the time most of my readership is approaching the nursing home stage of life, where 60% of current residents are on Medicaid, federal funding would be a tiny fraction of what it would be without the Republicans' change.
Again, it is absolutely legitimate to propose changes to Medicaid to help balance the budget. But it is not a change that should be made with only vague calls to "cut, cap and balance" the budget using historical spending rates to justify it, despite those historical spending rates not including those federal programs that millions of Americans are counting on.
Romney is actually on the right track with the idea to give more power to the states to tailor their Medicaid programs to the needs of their people. But Romney betrays his true goal by how he goes about reforming the program. He will lock funding cuts into the law and THEN hope that states can find the savings to provide their citizens with the help they need. The primary principle that he starts building from is that funding will be cut; continuing to provide necessary services is secondary. Were he to instead empower states first, along with financial incentives for states to find savings, and move to cut funding only after states demonstrate improved efficiency, we would know that he cares about the health of Americans more than slashing the budget. But that's not what he's proposing.
It's a very illuminating distinction.