There’s not enough talk about Medicaid now. The Republican health care legislation in both House and Senate versions makes big changes in Medicaid funding, but most Americans don’t realize how it will affect their families. It’s worth going beyond the over-simplifications of political ads to think about how we as citizens might be affected.
As my mother slowly declined in her 90s, she required more help in her daily life. She had a health care aide visit her own home daily for longer and longer periods of time. Then she lived with us, again with a daytime home care aide, a wonderful woman who became part of the family. After several years of slow decline, she needed more round-the-clock care than we could deliver, and moved into a nursing home, where she lived another four years.
My parents both worked all their lives, were careful savers, and had long-term care insurance. My mother’s financial resources lasted exactly to her death. Had she lived one more month in the nursing home, we would have had to apply for Medicaid to pay for her. Knowing that she could stay where she was and continue to get full care, even though she was running out of money, was an important comfort to all of us.
My father-in-law suffered with Alzheimer’s for 12 years. My mother-in-law took care of him for as long as she could, and then he spent 7 years in nursing homes with considerable daily care. He had done very well professionally, retiring as president of an envelope company with a generous pension. When his company was bought out a few years later, that pension was changed to a one-time payout, enormously reducing his lifetime benefits. I think that allowing companies to abrogate their promises to retirees is scandalous, but that’s another story.
In any case, his years of nursing care were paid by Medicaid. I don’t know exactly what was spent, but the average cost of the last five years of care for an Alzheimer’s patient in America is over $320,000, about $65,000 per year.
Medicaid is our country’s largest government health care program, bigger than Medicare, covering over 70 million people. That financial help for health care is targeted at the less affluent and the elderly. Here are the Americans covered by Medicaid: half of all births; 39% of all children; 30% of all adults with disabilities and 60% of all disabled children. Medicaid pays for nearly two-thirds of all Americans living in nursing homes. Although Medicaid is often thought of as a program for the poor, many of those in nursing homes, as in my family, were solidly middle class until paying for nursing care ate up all their savings.
Only 6% of Medicaid recipients are in long-term care, but because it’s expensive and continuous, that care accounts for nearly half of all Medicaid spending. These costs are shared by the federal government and the states, with each state having its own rules about spending.
Both Republican health care bills include giant cuts to federal Medicaid spending, about $800 billion over the next 10 years, according to the Congressional Budget Office. Although it’s hard to be precise, the bill would cut total federal Medicaid spending by about 25%, something candidate Trump promised he would not do. Individual states could either raise more money to make up the difference by increasing taxes or cut benefits to people who need health care.
The $800 billion Medicaid cut is nearly exactly the amount that the Republican legislation would give to affluent taxpayers in tax cuts. The new taxes on individuals making over $200,000 a year, that paid for the expansion of health care insurance under Obamacare, would be eliminated.
Think this is fake news based on the biased mainstream media? Here is what Republicans say about the Republican health care bill. Three Republican governors signed a letter to the Senate about the Senate bill: “It calls into question coverage for the vulnerable and fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the states. Medicaid provisions included in this bill are particularly problematic.” Nevada Senator Dean Heller said, “I cannot support a piece of legislation that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans.”
But those are not the priorities of Republicans in Congress. Both House and Senate Republicans created bills which do take insurance away from millions of Americans. They are cutting taxes on the rich by reducing care for the poor and the elderly.
Former Governor of Arizona Jan Brewer, a Republican, said, “We’re going to pay for it one way or another; there are no free lunches.” She’s wrong. The Republicans in Congress want the poorest and oldest Americans and their families to pay more for health care, while the rich get the free lunches.
Published in the Jacksonville Journal-Courier, June 27, 2017