The savage barbarity of the Republican Party’s actions on health care this week will be on full display in the coming years as elderly Americans are forced out of nursing homes due to the draconian Medicaid cuts imposed under the GOP Senate’s planned “replacement” of the Affordable Care Act, known as “Trumpcare”:
Medicaid pays for most of the 1.4 million people in nursing homes, like Ms. Jacobs. It covers 20 percent of all Americans and 40 percent of poor adults.
On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly entitlement. But little has been said about what would happen to older Americans in nursing homes if the cuts took effect.
Many, many elderly Americans now survive in nursing homes only through the grace of receiving Medicaid payments. The pennies and dimes they had saved all their lives are gone, or were long ago donated to their children who in turn spent them to pay their own bills, housing, or health care. Medicaid is all that many senior Americans have to keep themselves housed, fed and sheltered, and all that keeps them from being tossed out onto the street like unwanted human waste.
The popular perception among many white Americans is that Medicaid is something that covers only the urban (i.e., non-white) poor. Perhaps to underscore the inaccuracy of that perception, the New York Times visited Dogwood Village, a county-owned nursing home in Orange, Va:
The 150 residents of Dogwood Village include former teachers, farmers, doctors, lawyers, stay-at-home parents and health aides — a cross section of this rural county a half-hour northeast of Charlottesville. Many entered old age solidly middle class but turned to Medicaid, which was once thought of as a government program exclusively for the poor, after exhausting their insurance and assets.
Long-term services such as nursing homes in lily-white towns just like Orange, Virginia account for 42% of all Medicaid outlays. It is not simply a vehicle of care for poor minorities, but a critical lifeline to the folks in the heart of Trump country and everywhere else:
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.
As the article points out, many people nursing homes are not even aware they’re receiving Medicaid, as home administrators simply fill out the paperwork for them when their own health insurance (assuming they have any) expires. But even for those embarrassed by their dependence on a system of “government assistance” (which, incidentally, their taxes have paid into all their lives) such reliance on the assistance of Medicaid has now become the “new normal.”
Under current federal law, the states are required to pay for nursing home care through their Medicaid programs. But the Republican “Health Care” abomination slashes Medicaid to the bone, in addition to disproportionately impacting older Americans by forcing higher insurance costs on them due to their inherent frailty, many “pre-existing conditions,” and overall susceptibility to illness. These drastic cuts will force the states that administer Medicaid to do one of two things—decrease Medicaid payments overall or further limit the eligibility of people to receive them:
“The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”
The Times article points out that the Republican cuts to Medicaid will also impact those who don’t receive it, as institutions such as nursing homes which depend to a large extent on Medicaid payments for their services are forced to cut back on such things as staff, supplies, and other necessities.
What all this means in the real world is that the children of these elderly folks—many of whom are already hurting economically in their own lives--will be required to either pony up to keep their parents alive (because nursing homes also provide the medical care these elderly people need—that’s why they’re called “nursing homes”) or make the agonizing decision to reduce their care, keep them at home, or simply let them die. And for those seniors who aren’t fortunate enough to have children around who are willing to to care for them, it may mean homelessness.
A poll was released today showing that only 38% of Americans are even aware that the Republican/Trump “Health Care Plan” guts Medicaid for millions of Americans. That is what happens when a poisonous law is crafted in secret, without any public debate, and shoved down Americans’ throats. Many people still assume they are not going to be impacted by this law, and they will go about their daily lives next week as their Republican Senators vote for this monstrosity, oblivious to what is being done to them. But its horrific impact will soon be felt--not just by the poor, the infirm, or the elderly -- but by all of us.