Part of the Political Issues and Policies Special Report
Editor’s Note: The following is a guest essay and does not necessarily reflect the opinions of Next Avenue.
Dedication: Since this article will discuss a form of economic inequality, I want to dedicate it to a dear friend, Alfred Rotondaro. Fred, in his capacity with the Center for American Progress and Catholics in Alliance for the Common Good, was a fierce opponent of programs and policies that promoted economic inequality. He would be railing against the Senate health care bill, which would take so much from the poor and give so much to the wealthy. His voice may be stilled but his legacy of caring and compassion will live on.
The Affordable Care Act vs. Its Replacement Proposals
The Affordable Care Act (ACA) currently remains the law of the land. It has many notable features, including Medicaid expansion and other improvements to the program, and significant reforms to Medicare to make it stronger. It complements the premise of the Great Society program of 1965, which produced these two critical programs and have improved the lives of millions of older adults.
Contrast that to the efforts in Congress to repeal or replace the ACA, a key element in the winning campaign slogan of President Trump to “make America great again.” These efforts, if allowed to run their course, will savage Medicare and Medicaid as we currently know them and would prevent these programs from getting stronger as the ACA envisioned.
The bill proposed by the House of Representatives narrowly passed and was seen as mostly a political exercise, with no real chance of surviving as the final bill. To the surprise of many, the Senate bill, the oddly named Better Care Reconciliation Act, adopted some of the harshest provisions of the House bill, most notably as it relates to Medicaid.
Cuts to Medicaid
Let’s begin with the headline item: according to the Congressional Budget Office (CBO), some 22 million persons would lose health coverage over the next 10 years, including 15 million who obtained it through Medicaid expansion.
Further, Medicaid could sustain cuts of $772 billion over the next 10 years. A second CBO report said that Medicaid’s budget could be 35 percent lower by 2036 if the Senate bill were to prevail.
Let us put this in more human terms. Nearly two-thirds of the nation’s 1.4 million nursing home residents rely on Medicaid to cover their care. Estimates from the American Health Care Association added that the proposed cuts in Medicaid would cost individual nursing homes an average of $100,000 a year for the first three years, which according to the Washington Post, “would spell disaster for a typical nursing home, which makes about $150,000 annually.”
Home Care Will Also Be Affected
These proposed cuts come at a time when Medicaid has reached a pivotal new threshold. For the first time in its history, it is spending more on home and community-based care than institutional care. In fact, a recent New York Times article notes that five states — New Mexico, Alaska, Arizona, Minnesota and Oregon — spend more than two-thirds of their budgets for long term care on home and community-based care.
Yet this progress could be stopped in its tracks by the Senate bill. Medicaid must cover nursing home care but again, according to the Times article, state Medicaid plans don’t have to cover community or home-based care, which ironically could allow an individual to stay out of a nursing home. Whether it is because of pure cuts or imposing a per-capita limit on spending per person on Medicaid, these vital and cost-saving services could be sacrificed in the future.
Older Adults Will Bear Burden of ‘Making America Great’
When you also add two other provisions from the Senate bill, it again becomes obvious that older adults are being targeted. The first is the proposed elimination of taxes imposed on the wealthy and medical devices which, if repealed, would accelerate the date of insolvency for the Medicare trust funds by as many as four years. The second is the blatantly discriminatory process called age rating. In fact, under both chambers’ proposals, older adults between 50 and 64 can be charged five times more than younger adults for health insurance.
Whereas a central premise of the Great Society was to recognize the role of government in improving the quality of life for older adults, the idea of making America great again will come on the backs of older adults. The Senate health care bill is legislation that has no moral compass or conscience. It will take from the poor and vulnerable and bestow greater benefits on the wealthy. It disfigures the concept of “health care for all” and converts it back to “health care for those who can afford it.”
The opportunity is there over the coming weeks to stop the Better Care Reconciliation Act. It was stopped from being considered just before the July 4 Congressional recess and the time spent doing advocacy at the grassroots level could delay it even further. Why is it so important for everyone to care about these provisions? Perhaps the issue can be best captured in the headline from Ron Lieber’s article in the New York Times: “Plan on Growing Old? Then the Debate Over Medicaid Affects You.”
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