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.
Steve Hochstadt
Jacksonville IL
Published in the Jacksonville
Journal-Courier, June 27, 2017
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