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Linda Bergthold

Linda Bergthold

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Cut Medicaid? You May Have to Kick Grandma Out of the Nursing Home

Posted: 04/ 1/11 02:05 PM ET

We have been hearing a lot from the Republicans about cutting Medicaid and Medicare. How much do you know about these programs? Take this little quiz:

1) Who qualifies for Medicare?
A) People over 65; B) People over 65 and some people with disabilities; C) People over 55; D) All of the above

2) Who qualifies for Medicaid?
A) People who are poor; B) Only certain categories of people who are poor like children and single women with children; C) Some people in nursing homes; D) B and C; E) None of the above

You may have guessed (B) that Medicare is a health insurance program run by the federal government for people over 65 and some people with disabilities (a single payer program actually!). What about Medicaid? Did you think it was a health insurance program for anyone who is poor? If you did, you would be only partly correct. To be eligible for Medicaid you do have to be poor, but it is not a program for everyone who is poor -- only certain "categories" of the poor like children, pregnant women, single women with children, people with disabilities and the elderly. If you are a poor adult male who is not disabled, Medicaid does not cover you. The dirty little secret about Medicaid is that about a third of the budget goes for people in nursing homes, so cut Medicaid and you are likely to cut grandma as well. (The best answer would be B and C.)

Who relies on Medicaid? Children account for about half of all Medicaid enrollees but only 1/5 of the spending. One quarter of the enrollees are people with disabilities and the elderly but they account for two-thirds of the spending. An even lesser known fact is that between a third and half of a state's Medicaid budget can go to pay for nursing home care for elderly and disabled people who cannot live at home. A year in a nursing home now averages $72,000, and it doesn't take a math genius to figure out that an ordinary middle class person who has saved for his or her retirement can now "spend down" all that money fairly quickly, ending up on the Medicaid rolls.

Did you think Medicare paid for nursing home services? Medicare pays VERY LITTLE. At best, maybe a month in a nursing home after a hospitalization. But what if you are seriously disabled and simply can no longer live at home, have no family, no other resources? You would be dependent on Medicaid -- that is, if it still covered for people like you in your state.

Why so much fuss about cutting these programs and why do the Republicans want to replace the programs with blocks of money given to the states to administer (called "block grants")?

As we have already seen with Arizona, a Republican Governor and legislature can decide that Medicaid will no longer pay for organ transplants or can cut 250,000 current recipients from the Medicaid rolls; or as in Minnesota, funding cuts can be proposed for services to the elderly in nursing homes; or Texas where the program now faces up to $7b in cuts, endangering the care of disabled children. If this program were turned over to the states, it would greatly depend on what state you live in as to whether or not you would get the services you need. If you were lucky enough to live in New York or California, you might be ok. If you lived in Texas or Florida or Arizona, move!

Republicans and Tea Party types are quick to talk about cutting Medicaid costs, and they propose to cut $1 TRILLION from Medicaid over the next ten years. But there are very few good solutions to the increasing costs of health care for these populations without seriously damaging the program. About 60% of Medicaid spending goes for hospitals, doctors, drugs, and 30% for nursing homes. Doctors and hospitals who treat Medicaid patients get much less reimbursement than what private insurance or even Medicare pays, so it would be difficult to cut their reimbursement much more without driving them out of the program entirely.

Some states have tried different managed care models for Medicaid, with mixed success. California has done better than most, and Florida much worse.

If Republicans were to succeed in defunding health reform and returning the management of not only Medicaid but Medicare and all health programs to the states, as they have proposed in a rather radical proposal called a "health care compact", states would lose the federal matching money they currently receive (which is substantial), and we would be at the mercy of state ideologues who apparently know very little about the programs they claim to cut. Rolling back Medicaid expansion under the Affordable Care Act would deprive 15 million currently uninsured people of coverage, according to Jonathan Cohn of The New Republic.

The Tea Party will soon become this century's version of the Know Nothing party, They talk a good game about deficit reduction and small government, but they don't seem to know what these types of cuts mean to real people in their own neighborhoods. It could well be their own grandma who is kicked out of the nursing home and back into their own home, where, god bless 'em, I hope they have a lot of time and money to take care of her!

Thankfully, the Democratic Party has vowed to fight these cuts to the Medicaid program.
Democrat Chris Van Hollen (D Md) has said:

"Block granting Medicaid is simply code for slashing health care support for seniors, people with disabilities, and others," he said. "It is not reform. It does nothing to reduce health care costs. It simply gives governors a blank check and a license to deny critical care to millions of seniors and to people with disabilities."

Update: It was just announced that the GOP House 2012 Budget proposal will be released next week. It will contain proposals to put Medicare into a voucher program (you would get a fixed amount of money and would have to find coverage on your own), shift all federal money for Medicaid to the states in the form of the block grants I mentioned above, and make permanent the tax cuts for the rich. That is your Republican party, folks! Like it or leave it!

 

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HUFFPOST SUPER USER
booker52
avid reader
09:56 AM on 04/04/2011
Its the bagger mentality, everyman (or woman) for themselves. I've got mine, you can get your own. That's the thinking, too bad the elected reps get theirs on our dime, then want to kick us to the curb when we try to get ours.
HUFFPOST SUPER USER
memosyne
09:53 AM on 04/04/2011
The worst program to cut is family planning. Every unwanted child that is conceived costs us money. A woman has a very good reason for not wanting a child: Perhaps she is poor, not finished with her education, already has as many children as she can decently raise, is addicted to a substance harmful to a fetus, is in an abusive relationship, has a medical condition requiring treatment damaging to a fetus, or simply doesn't want to be a mother.
In all of these situations a child is at risk for abuse, neglect, or disability. These cost us tax money in child protective services, special educational services, medical costs, and eventually many of these children end up costing us juvenile justice money and prison money.
Providing voluntary access to contraception prevents the conception of an unwanted child and saves the taxpayer a lot: beginning with Medicaid payments for prenatal, obstetrical and neonatal services.
A woman who doesn't want a child knows why. We need to trust her. Don't help with or support abortion if you don't want to, but contraception is seriously important.
My charity donations go to family planning programs.
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HUFFPOST SUPER USER
armadillo
Gee, I miss Ann Richards.
01:20 AM on 04/04/2011
How about the folks on medicaid and medicare who voted for the Repubs getting cut out. I'm all for that. That and figure out how much they contributed to Social Security and refund it .... plus interest. One draw back.... Once you're off... you're off. So if you have a catastrophic illness and lose all of your money nit's your problem.

Faced with option, the talk would stop they would run for the hills.
HUFFPOST SUPER USER
rtx47
11:48 PM on 04/03/2011
gen-x mom2: I went through something similar with my grandmothe­r last year. The doctors at the hospital kept pushing for more and more. She was 89 for Pete's sake, how much more should they have to endure?
--------------

Please follow the logic! I salute you for your courage to make a difficult decision.

Yet what was the purpose of your grandmother, in a terminal state, to be in a hosptial? She and the family should accept the inevitability of the situation (which you did) and then the patient (like 90% of seniors desire) should be given the dignity, comfort and security of being in their own bed in their own home surrounded by family and friends and cared for by hospice.

So please do not blame the hospital and doctors for 'pushing the care'. That is why the patient is in the hospital (or family kept her there). The hospital will push care; lest a far-off relative shows up (now or later) and sues the hospital for not doing enough to correct the high sodium blood level.
08:47 PM on 04/03/2011
What about the CBO estimated 100 to 250 million in fraud? Medicaid payment system is a recipe for fraud; pay first and then research (or not) the claims.As with any Government program, the delivery system is woefully inefficent and fraught with abuse, something never adressed. The Dem answer is always.....throw more money at it, regardless of the fact that outcomes continue to decline as costs contiunue to soar
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HUFFPOST SUPER USER
SmileAndActNice
Utilitarianism, the -ism that works.
09:57 PM on 04/03/2011
So which is it? Is the delivery system ( of money, since we aren't talking something nice like the Brittish system where doctors work for the government. ) woefully inefficient or do they pay so fast that they can't vet anything?

Make up your mind.
10:26 PM on 04/03/2011
The top heavy, bureaucrat choked program is a mess. I wouldn't want a govt. employee operating on me and I doubt you would either. Paying for services not rendered IS the height of inefficency. These Medicaid mills operate in all 50 states but the govt.'s own estimates is their catch rate is 5%, and prosecutions are almost non existent.....inefficent....I guess
This user has chosen to opt out of the Badges program
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08:31 PM on 04/03/2011
I just bumped into an old friend yesterday and I asked her why she was no longer working at her job. She told me that she had to take a year off from work (leave of absence) because her father is in poor health. He has kidney problems and Altzhiemers BUT because he can still walk and feed himself a nursing home would be self pay at 7 grand a month. Who has that money just sitting around each month? Now my friend has no job as her year is up and sadly it appears, no life at the moment herself.
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HUFFPOST SUPER USER
gen-x mom2
09:44 PM on 04/03/2011
such a sad story,unfortunately one that we are hearing too often these days.
HUFFPOST SUPER USER
independentlib22
06:14 PM on 04/03/2011
If Obama and the Democrats in the House and Senate let that happen then that is your Democratic party too folks.

There used to be a difference. Real Democrats would NEVER allow such things. Real Democrats are the ones like LBJ who gave the people Medicare and Medicaid in the first place.

Now we have Democrats like Obama who only fight for the rich. You know those Obama tax cuts for billionaires are going to be forever and the worst nightmares for those on Medicare and Medicaid and eventually SS are going to come true.

We need to elect someone who is what a real Democrat used to be. Only now he or she would have to be independent from the Democrats and the Republicans and someone who is proud to be called a Liberal.
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05:49 PM on 04/03/2011
Reagan signed the amnesty and engaged in massive deficit spending and all Republican administrations have followed suit outspending Democrats every time since except for Obama who was implementing the previous administration's bailout and spend ideas after Bush wasted a fortune charging Iraq for those missing WMDs instead of stopping a domestic economic meltdown.

Republicans are only fiscal when it comes to hurting the elderly and poor sick unemployed Americans in a Great Recession. The rest of the time they are Spendocans who lie about it.

They won't let Asia and Europe pay for their own defense, they spend trillions on that each decade. They spend trillions more on wars all over the globe. They pass trade legislation that only helps the top 1% wealthiest and largest corporations but hurts the American worker and small businesses.


Sounds like Republican sponsored democide on Americans to me. The people see these crazy loons for what they are. Instead of spending trillions to protect Europe, South Korea, Iraq, etc... and passing a law to make medical providers accept a revised Medicare/Medicaid rate schedule, they just want to toss all the poor sick and elderly Americans under a bus.

If they really wanted to help the country they would simply make medical providers take revised Medicare and Medicaid rates, stop spending trillions trying to take over the world, and let Asia and Europe pay for their own defense. It shouldn't cost much in Europe's case. They have nothing to defend against anymore.
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HUFFPOST SUPER USER
skylark
Tangled up in blue..
08:43 PM on 04/03/2011
Fanned!!!
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unionave
Old Codger
01:07 PM on 04/03/2011
Corporations/Republicans are without conscience or caring . They only know profit . Medicare and Medicaid are government ran health insurance programs that compete with corporate health insurance corporations . And as long as those government managed programs are in existence it limits the profitability of the private corporations . Because the people have other options . So the aim of the corporations/Republicans is to kill the competition .
As usual the concerned parties are attempting to morph the conversation in to a two sided political debate and claim victory after the smoke clears .

What is never mentioned in the debates is that Medicare is paid for until death . As long as an American is earning wages they are paying Medicare premiums , and after 65 when the Social Security checks start rolling in Medicare charges are deducted before the check is sent . And those charges are increased annually . Which means Medicare like Social Security is a bought and paid for program . Both were enacted to give the retired some security and pride in not being a burden on their family .

Several members of Congress have profitable reasons for wanting these corporations to be more profitable , and their income is much more important to those members than the pain and humiliation the reduction or destruction of Medicare or Medicaid would cause . How profitable has the health insurance corporations been recently ?
This user has chosen to opt out of the Badges program
08:45 PM on 04/03/2011
You really nailed it. Both of the two comments above should be published in the NYTs and every every major news paper in the country. Anyone who can post them in other b;pgs should do it.
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unionave
Old Codger
11:04 AM on 04/04/2011
f/f ! If we would all push the political oneupmanship aside and focus on the truth of how this war is being waged and to whose advantage we would be less divided . We can not win divided .
12:01 PM on 04/03/2011
In a world of free trade and globalism the US will be forced to change its culture. The rest of the world has their elderly live them in large extended families. If we want US workers to compete directly with China and India then we will be forced to live that way. So you either need to fight free trade or get ready to live with and take care of grandma yourself with no government help.
11:18 AM on 04/03/2011
As a geriatric social worker, I suggest that if anyone has assets, they should spend some of their assets to legally hire an estate planner for their parent of themselves. They've changed the laws for that recently, but I'd still recommend it. Say, for instance, that your mother has 100,000 dollars, the money will either go to a lawyer who will help you, or a nursing home- I 'd rather give it to a lawyer because yes it's legal and there are ways to gift monies- though not as easy as it used to be. So yes, wealthier people can gift monies to qualify for Medicaid- but yes I'd do it because if millionaires find loopholes, so should middle class people.
12:03 PM on 04/03/2011
Its less about creating loopholes and hiring lawyers and more about questioning why its ok to charge 80,000 + a year for nursing home care in the first place. If people are going to continue to live to old-old age, there has got to be a better way to provide long term care. Either that or we should stop and think about what quality of life means as we age. Maybe taking pills and meds to prolong our time on earth isn't worth if it merely means we'll spend our final years broke and in a nursing home.
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HUFFPOST SUPER USER
FiredUpRTG
Don't start no stuff; won't be no stuff…
12:59 PM on 04/03/2011
Well, if you actually add up a nursing home resident's share of nurses' salaries, nurse aides, custodians, security guards, medicines, med equipment, laundry service, utilities, tv service, food, food preparation, etc., $80K sounds about right, kinda low in some areas of the US.
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stewartm0205
11:03 AM on 04/03/2011
It won't be the tea party member grandma that will be kicked out of the nursing home. It will be the tea party member herself. Most of the tea party are retired seniors who will need a nursing home is a few years. its a pity none will be available to them.
10:52 AM on 04/03/2011
Nothing was said about the high cost of drugs. As an example, last year Nexium cost me $167. This year over $180. Yet I can buy it in Canada for one third the price. It's hard to imagine the cost of making this drug went up by 10%. Now someone in a nursing is likely to be on several prescriptions. Why are we paying more for drugs here than other countries. I wonder if congress has the will to take on the drug companies. My guess is that its's the drug companies who own congress.
11:00 AM on 04/03/2011
Because we have to pay their high salaries and for their silly TV advertising
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HUFFPOST SUPER USER
Martin Houde
I am no microbe
02:50 PM on 04/03/2011
Regulations, and socialized medecine and pharmacy.

The government negotiates the drug prices, and the amount it covers in insurance.

In Quebec, the drug insurance is like the US's proposed health care plan with the public option. Drug insurance is mandatory ; if you don't (or can't) have it from the private (through employer, or other), you have to get it from the provincial government. But the government decides which drugs it covers, and how much of it it covers. Health care itself is single-payer and covers drugs used internally in hospitals (in most cases, that is).

Very few people seem to know that our "highly expensive" single-payer system is actually way more cost-efficient that the US's... In total costs (from patients, insurance, government, etc), it costs more per patient in the US. The administrative part of the bill is 15% in Canada, compared to 30% in the US. The difference ? In Canada, you pay for the bureaucracy. In the US, you pay for the bureaucracy...and the insurance companies' lawyers and profits...
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HUFFPOST PUNDIT
TeraWatt60
Cogito Ergo Sum
04:52 PM on 04/03/2011
Actually, it is the Tea Party types that don't understand that.  During the Health Care debate one of my favorite signs held up by Tea Party types was "NO to Socialized Medicine! Hands off my Medicare"  sad but true.

In the US Medicare Part D will cover the cost of drugs but ,by law, can not haggle with the drug companies Republicans "thought" that was a bad idea
10:23 AM on 04/03/2011
Most of the Tea Party are working for the Health Insurance companies.

The Health Care Reform is not perfect, but it keeps the health insurance companies from dropping you if you become sick. It lets your children stay on your insurance.

They have to sell you insurance even if you already have something wrong with you.

There is so much in the HCR that really helps the rest of us. I posted it the other day. Google it.
bcunnin679
Political Correctness, the enemy of free speech
05:05 PM on 04/03/2011
Most of the Tea Party are working for the Health Insurance Companis?

Please explain that statement
09:56 AM on 04/03/2011
I have worked in the geriatric social work field for nearly 20 years. Honestly, so many people that I see have NO CLUE how the system works until they or a family member need nursing care and there's a crisis. The myth is that Medicare will cover a lot- that's false. Medicare covers ONLY 80 percent of SKILLED nursing needs, and medical care in hospitals if you have part B which is $96 a month on you're on Social security- something that hasn't been raised in 2 years. Nursing homes in my area run around 9000-10,000 a month for mediocre care. Medicare covers 100 skilled days at 80%. If you get help in the home, we can only provide , if you're lucky , 4-6 hours a day, most people just get 2 hours- and these are people who are nursing home look alike clients. If you do get Medicaid and own a home and aren't married- and the house isn't under anyone else's namefor 5years, you could go on Medicaid and your estate will owe the Medicaid $$ back after you die, it's called MA Estate Recovery. People think they have enough to retire on- but realistically, who has 9000 a month for a nursing home? Medicaid=welfare but I have not yet met one Republican who refuses to apply for it when they need it. We don't even call it welfare, we call it a GRANT so that the older people do not feel embarrassed.
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HUFFPOST SUPER USER
Chris Wundrow
10:52 PM on 04/03/2011
In Wisconsin, they just put a lien on a patient's house, so when the kids sell the house, the first one to get paid is the state, and sometimes they get the whole shooting match, and the kids get bupkis!
HUFFPOST SUPER USER
rtx47
11:32 PM on 04/03/2011
Well then the kids should have looked after mom.:=))

If its dad, it may be his recently married young widow that'll get the assets.