Wednesday, July 19, 2017

Throw Mama from the Train: Why Medicaid Cuts Will Destroy Long-Term Care

One of the good things about the otherwise distressing health care drama in Congress is that people are becoming aware of the fact Medicaid is important to everyone.  As Ron Lieber wrote in the New York Times, the Medicaid debate is important to everyone who plans to grow old.  That’s because Medicaid pays for much of the nursing home care in this country.  That’s right—Medicaid, not Medicare, which pays very little toward nursing home care. 

According to a Kaiser Foundation study, 1 in 3 people will spend some time in a nursing home.  That could be you or me.  Since the United States alone among economically advanced countries has no national long-term care insurance program, you will have to pay for care, which can run $100,000 a year or more.  If you run out of money or can’t pay when you are admitted, that’s where Medicaid comes in.  Currently, 62 percent of nursing home residents are on Medicaid.  Medicaid also pays for home and community-based services that are increasingly being used to help people stay at home longer.

The proposed cuts in the hopefully defunct House and Senate bills to replace the Affordable Care Act would have taken a huge chunk of federal dollars from Medicaid.  The federal government pays 62 percent of Medicaid, and states pay the rest.  Currently, the amount paid by states represents 19.5 percent of state budgets nationally, although the percentage varies by state.  Can you imagine your state increasing substantially the amount that it pays for Medicaid?  Our state legislature can’t pass a spending bill to fund the budget they already passed for the fiscal year beginning July 1.   It’s more likely that states would go along with most of the cuts and reduce spending on all of the Medicaid programs.  Inevitably, that would mean fewer nursing home beds and less funding for home and community-based programs that keep people out of nursing homes. 

Along with Medicare, Medicaid was part of President Johnson’s Great Society Program.  It was designed to provide health care for poor people, but has become the de facto method for paying for nursing home care.  This stretches the already limited resources allocated to Medicaid.  It has also allowed politicians to ignore the fact that many people become infirm and need assistance near the end of life.  The need for long-term care is one of the costs of a longer life expectancy and we need to find a better way to pay for it.

What would that involve?  Many countries use portions of general tax revenue to pay for long-term care.  In Japan and South Korea, a tax comes into effect when people are 40 to pay for long-term care.  That is a clever approach, because by 40 it begins to dawn on many of us that we will need to care for parents and may need care ourselves. 

Of course, given the deadlock in Congress, it is hard to imagine new taxes to cover long-term care, when they can’t even agree on health care.  The problem is not that a long-term care program would lead to higher taxes, but that many Republican politicians are fundamentally opposed to government programs and would be glad to get rid of Medicaid, Medicare and Social Security.  

So even if you are experiencing Trump-fatigue from responding with letters and emails and hopefully some actions to defend against each new outrage, keep your eyes on health care reform and what could happen to Medicaid and Medicare. You may be part of the 1 in 3 who spend time in a nursing home, and even if that’s not the case, it’s still the right thing to do.

The photograph was taken in Stockholm.  The shop combines two favorite things of our Swedish friends—coffee and a good bargain.  Swedes also enjoy some of the best long-term care in the world.  You can read about how the Sweden does long-term care in our series of blogs from May, 2016.   Brew a cup of strong coffee, sit back and read what a country can do with the determination to get supports for older people right.

Also, look at the excellent columns by Ron Lieber about Medicaid in the New York Times: