Texas Governor Rick Perry has made a fetish of his fondness for cutting Medicaid. As governor he requested a waiver from the federal government to create enrollment caps in Medicaid and additional federal dollars to establish a Texas pool to help low-income people buy private insurance. The request was denied by the Bush administration, which stated that Perry’s proposal to limit lifetime Medicaid benefits to $25,000 was too restrictive for people who need long-term care. 

More recently Perry signed a law that asks the federal government for permission to turn Medicaid into a block grant program and could privatize Medicare. In debates and on the presidential campaign trail he has expressed a desire to turn Medicaid into a block grant program so as to give states more flexibility in allocating funds. If Perry becomes president, it is a safe assumption he will propose some sort of block-granting scheme for Medicaid. Certainly, he would be amenable to the block grant proposal in Paul Ryan’s “Road Map” to inequality.

That’s a chilling thought for people with disabilities, many of whom rely on Medicaid to provide essential services. “When people call for flexibility, you have to say, Flexibility to do what? To eliminate eligibility?” says Lara Schwartz, a spokesperson for the American Association of People with Disabilities. “It’s one of those ideas where you can say ‘states’ rights’ and it sounds like a fundamental value. Texas has a very high rate of uninsured people and a high rate of people in poverty. When I hear ‘I want the flexibility,’ I hear ‘to take away things people need.’ ”

Indeed, Perry does frame his views on Medicaid in the context of his larger support for states’ rights. If you look at Perry’s whole array of startlingly extremist right-wing positions such as opposing the direct election of senators, it becomes apparent that Perry’s desire to block grant entitlement programs is as much a part of that view as it is his fiscal conservatism. Liberals—and most Americans who think the right side won the Civil War—believe that all Americans are citizens of our country first and foremost. This view is best encapsulated in the first section of the Fourteenth Amendment, which reads:

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

From that it follows that our society as a whole has certain obligations, such as providing health care for the disabled and impoverished. Today’s Republicans, however, think states should be free to run roughshod over their most vulnerable citizens, just as they did back in 1964. And they don’t care much for the Fourteenth Amendment. Consider, for example, that many of them want to revoke the “birthright citizenship” granted to the children of undocumented immigrants born on American soil.

To be sure, Perry’s animus for Medicaid derives from his miserliness toward the poor as well as his antiquated view of states’ rights. In the last legislative session Perry insisted on cutting $5 billion from Medicaid instead of using a flush rainy-day fund. The result? Cutbacks in eligibility and services for people with disabilities, among others. “We have people who get in-home services: in-home attendants, therapies: all of those services are being reviewed and limited,” says Bob Kafka, an organizer for ADAPT of Texas, a statewide disability rights organization. “Voucher services that people have been getting to buy needed equipment, all those have been reduced.”

That’s just a taste of how bad the service reductions would be if Medicaid were turned into a block grant program. A block grant, unlike an entitlement program, does not get additional spending for the extra applicants during an economic downturn. So right now Medicaid would be feeling a terrible pinch and states would cope by dropping recipients or the services they receive. The worst hit would be people with disabilities, who are disproportionately likely to be poor and to need the services Medicaid provides.

As Think Progress notes, Texas “has the narrowest Medicaid eligibility standards and spends the second least of any state on healthcare for the poor per capita.” That’s what the rest of us can look forward to it Perry becomes president.