This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
The media and many politicians focus on Medicaid's support for the poor. That ignores a bigger policy and political problem for states. It's one thing to cut support for people who Kellyanne Conway thinks need to go out and work (actually, about 80 percent of adults on Medicaid live in a household in which at least one person is employed, which shows how much the White House cares about the topic); it's another to throw people's grandparents out of nursing homes.
A recent Kaiser Health News article on the PBS Newshour web site explained the scope of the issue:
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Medicaid pays for about two-thirds of the 1.4 million elderly people in nursing homes. . . . It covers 20 percent of all Americans, and 40 percent of poor adults. . . . Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.
"Medicaid pays for about two-thirds of the 1.4 million elderly people in nursing homes. The states are going to make it harder to qualify medically for needing nursing home care," predicted Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. "They'd have to be more disabled before they qualify for Medicaid assistance."
States might allow nursing homes to require residents' families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.
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Many of these elderly people have families who themselves are struggling to make ends meet. If Medicaid support goes down, they'll need to dip into their own savings. ("A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation.")
In addition to complaining that the House's American Health Care Act and the Senate bill would allow insurers to charge seniors up to five times more for premiums than they charge younger people, AARP, unsurprisingly, blasted the Medicaid cuts. "These changes mean less federal money would be available to the states for Medicaid. Starting in 2025, the rate of growth of the per capita cap would decline significantly, meaning even deeper cuts to the program," AARP said in a statement. "Given the aging demographics of the country, the cap would not keep pace with the funding necessary to support the needs of the senior and disabled population." That, in turn, means bigger out-of-pocket costs for them or their children and grandchildren.
President Trump, of course, had promised to protect all entitlement programs. Not only are many of his voters older, but also his core support is among white, less-educated, working-class voters who are the ones least able to afford new payments to keep up care for elderly relatives - or bring them to live with them instead of at nursing homes and assisted-living facilities. Howard Bedlin, vice president for public policy and advocacy for the National Council on Aging, blasted the Senate bill for this reason. "In particular, the bill will pull the rug out from under millions of families who are struggling to keep their spouses, parents, and grandparents out of nursing homes.," he said. "This is because states are required to pay for care in nursing homes, but care at home is optional. Overall, Medicaid covers 2 in 3 nursing home residents and pays for over 60 percent of Americans' long-term care costs."
Florida has the highest percentage of retirees (19.1 percent), followed by Maine (18.2 percent) and West Virginia (17.8 percent). Sens. Marco Rubio, R-Fla., Susan Collins, R-Maine, and Shelley Moore Capito, R-W.Va., should consider how they would defend Medicaid cuts back home.
Finally, Republicans are taking one more shot at seniors. Recall how big a deal Republicans made about taking more than $700 billion out of Medicare to pay for the Affordable Care Act. Once upon a time (in 2012), now-House Speaker Paul D. Ryan, R-Wis., told campaign audiences, "The president raids $716 billion from Medicare to pay for the Obamacare program." Ryan would even bring his mother out to assure crowds how much he cared about seniors. Both the House and Senate bills do not put that Medicare money back in. Instead, they take a second whack at seniors by depleting funds available for extended care. How does that comport with Republicans' claim to care about family values and the dignity of every person?