In this post, I am looking at what’s at stake for elders currently on Medicaid. The AHCA or American Health Care Act (a/k/a Trumpcare) narrowly passed through the U.S. House, with twenty Republicans voting against it. It faces more hurdles in gaining Senate approval, but the Senate is now considering the proposed law.
Medicaid is of course a government “welfare” program which came into being (along with Medicare) in 1965 when President Lyndon Johnson signed into law the bill leading to the establishment of both programs. While many people think of the stereotypical mom and kids when they think of Medicaid – they were a primary source of concern for the original Medicaid program after all – there are many elders who are sick enough and poor enough to qualify for Medicaid.
How is the financial stability and well-being of elders on Medicaid threatened by this proposed law?
Colorado has been one of the many states in which “Medicaid expansion” has boosted enrollment in the insurance rolls of elders, the rural poor and other populations. In Colorado, Medicaid is known as Health First. The AHCA proposes, among many other huge changes, to move the funding to a “block grant” system in which each state will be given a grant for their Medicaid recipients. Here’s a recent Denver Post article which discusses the impact of such a grant on Colorado’s budget. Leaving the states to shoulder more of the Medicaid funding sounds like a good way to offload federal Medicaid as we know it, but it will change the landscape of health care services available to poor elders, particularly in rural areas, in ways we cannot foresee. And I do not mean for the better!
How has the payment of health care services changed over the years?
I remember my father telling me about the circumstances under which my oldest brother was born in a hospital in Denver sixty-six years ago: the nuns weren’t happy with him because he couldn’t pay for my mother’s delivery (it was a bit complicated) with cash on the spot. Yes, those were the “good old days” in many ways, when many Americans paid for lots of routine things (including the hospital stay for the birth of a child) out-of-pocket. I found this colorful graphic from the California Health Care Foundation, which demonstrates how the source of health care payments have changed since 1960 through 2014. If you want to look at some more color graphs, check out this collection of instructive slides in Louise Shiner’s pdf entitled Understanding the Slowdown in Heath Care Spending Growth. In today’s “health care” environment, many of us need assistance for paying premiums, with getting needed prescription drugs and related items we couldn’t otherwise afford. Long gone are the days when we routinely paid out of pocket for medical care!
So – who will pay for the elder’s medical care if Medicaid as we know it. . . . disappears?
Based on information from the Medicaid.gov website, Medicaid provides health coverage to more than 4.6 million low income elders, nearly all of whom are also enrolled in Medicare. Medicare has four basic types of coverage:
Part A: Pays for hospitalization costs
Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
Part C: Medicare Advantage Plan (like an HMO or PPO) offered by private companies approved by Medicare
Part D: Assists with the cost of prescription drugs
Medicaid can assist low income elders in paying their insurance premiums and out of pocket medical expenses; it can also pay for additional services beyond those paid for by Medicare – like long term nursing care, prescription drugs, eyeglasses, and hearing aids. Medicaid can often make a difference in providing the needed care or services by covering the shortfall from the difference in Medicare payment limits and the costs to the patient.
Here is a fact sheet from Justice in Aging which identifies what the “block grant” funding proposal would mean for elders on Medicaid.
Bottom line is that poor elders would receive less medical care or lower quality care as a result of the belt-tightening of the states providing those Medicaid services to their recipients. People who have a period of ineligibility – like if they inherit a sum of money from a sibling or child – would not be able to re-qualify for future Medicaid services.
I don’t usually like to write these kind of “scary” blog posts, but as an elder law attorney I am deeply troubled by what might happen to some of the most vulnerable persons in our country (disabled adults) if the AHCA is passed. I’m only mentioning in passing that Medicare premiums will rise – remember those tax cuts in the AHCA have to land somewhere! Under the block grants, states will be free to retool their own stricter rules and I would imagine that some states will be looking to filial responsibility laws for shifting their burden to requiring the children to pay.
© Barbara E. Cashman 2017 www.DenverElderLaw.org