Congress’ latest effort to repeal and replace the Affordable Care Act has a clear message for the American people: If you live long enough to need more expensive health or long-term care, you’re on your own.
While anyone may experience increased needs for health care and long term care at any time, we know that as we age, our need for health care – and long-term care – grows. But the Senate’s Better Care Reconciliation Act – like the House’s American Health Care Act – will only make it harder to get the care we need as our needs grow.
Imagine an 84-year-old widow with dementia (I’ll call her Barbara) whose daughter made the difficult decision to move her into a nursing home two years ago. When Barbara was first admitted into the nursing home, she used her savings to pay the $80,000-a-year cost. Since exhausting her savings three months ago, Medicaid has been covering her care – as it does for more than 60 percent of all nursing home residents.
The Senate health care bill caps and cuts the Medicaid program, leaving seniors like Barbara at risk of losing care. The bill reduces federal Medicaid spending by $772 billion over 10 years, with larger cuts to follow in the subsequent decade. With less federal Medicaid money, states will be forced to cut services or limit the number of people on Medicaid. Seniors like Barbara may lose eligibility for Medicaid, as states work to thin Medicaid rolls. The state may also reduce rates it pays to nursing homes, which may reduce the quality of care provided and increase the potential for abuse and mistreatment.
Consider Jack, an 80-year-old man who still lives at home despite difficulty performing everyday tasks. He is only able to stay home because of the personal care services he receives with support from his state’s Medicaid program. After a lifetime working on a factory floor, Jack’s savings are not enough to cover the $20,000 a year he would need to pay the personal care attendant who comes into his home several times a week to prepare meals, help him bathe and dress, and make sure he’s safe. Without her support he’d likely need to leave his home and live in a much more expensive nursing facility
Medicaid programs have the option to cover home-based long- term care services like Jack receives. This works out better not only for the majority of people who prefer to remain at home, but also for the Medicaid program, because it saves money that would be spent in more costly nursing homes. But states are not required to cover home-based services, while they are currently required to cover nursing home care. If states receive less Medicaid funding from the federal government they will likely cut these optional programs, leaving seniors like Jack without a way to get the care they need at home.
The proposed cuts in the Senate bill will also fall hard on recent retirees and near retirees. Mary, a 64-year-old woman with diabetes, works part time in a job that doesn’t offer insurance, earning $26,500 per year. She is not yet old enough to qualify for Medicare, so she purchases health insurance coverage through the Affordable Care Act (ACA) Health Insurance Marketplace. Because of her income, she qualifies for need-based subsidies that help her pay for her coverage. Thanks to those subsidies, she pays a premium of about $1,700 per year.
The Senate bill changes the current premium subsidy structure resulting in a nearly 300 percent premium increase for Mary and older adults like her. In addition, the deductible under her plan will climb to $6,000 per year. Her out-of-pocket costs would total nearly half her income. Mary’s care would become unaffordable and she would likely enter the ranks of the uninsured. The Senate bill would result in 22 million additional uninsured people by 2026 – including four million age 50-64.
The consequences of this bill are clear for older adults like Barbara, Jack and Mary. Less care, higher costs, lower quality, and, yes, it is true, potential death. These seniors all have serious and significant health care needs and without services their lives are at risk.
This is a bill that can’t be fixed with a couple of tweaks or backroom deals. The bill isn’t really a health care bill at all. It’s a tax cut for millionaires built on massive cuts to Medicaid, decreased spending on subsidies that make care affordable, and the rollback of consumer protections that ensure older adults with pre-existing conditions get the care they need. Congress could have developed a bill that maintained Medicaid long-term care services for seniors, reduced the cost of premiums and deductibles, expanded coverage and limited the number of uninsured. But that would have to be an entirely different bill.
When I grow old, I want to be able to visit a doctor when I need to, get the care I need at home or in a nursing home. I want my kids to be able to visit me, help out when I need them, and bring my grandchildren to visit. I don’t want them to have to give up their own lives and careers, or go bankrupt paying for my care. I’m sure you and the lawmakers in Washington want the same things. It’s time that we as a society recognized that all of us will need help sometime in our lives due to disability, or as we grow older, and work together to invest in a system that will be there for all of us when we need it.
Photo courtesy of Louis Kravitz for Justice in Aging.