Tuesday, January 16, 2018
Opinion

Column: You're probably going to need Medicaid

Imagine your mother needs to move into a nursing home. It's going to cost her almost $100,000 a year. Very few people have private insurance to cover this. Your mother will most likely run out her savings until she qualifies for Medicaid.

This is not a rare event. Roughly one in three people now turning 65 will require nursing home care at some point. Over three-quarters of long-stay nursing home residents will eventually be covered by Medicaid. Many American voters think Medicaid is only for low-income adults and their children — for people who aren't "like them." But Medicaid is not "somebody else's" insurance. It is insurance for all of our mothers and fathers and, eventually, for ourselves.

The American Health Care Act that passed the House and is being debated by the Senate would reduce spending on Medicaid by over $800 billion, the largest single reduction in a social insurance program in our nation's history. The budget released by President Donald Trump would up the ante by slashing another $600 billion over 10 years from the program. Whether the Senate adopts cuts of this magnitude or not, any legislation that passes the Republican Congress is likely to include the largest cuts to Medicaid since its inception.

What has been largely missing from public discussion is the radical implications that such cuts would have for older and disabled Americans.

Medicaid is our nation's largest safety net for low-income people, accounting for one-sixth of all health care spending in the United States. But few people seem to know that nearly two-thirds of that spending is focused on older and disabled adults — primarily through spending on long-term care services such as nursing homes.

Medicaid pays nearly half of nursing home costs for those who need assistance because of conditions like Alzheimer's or stroke. In some states, spending on older and disabled adults amounts to as much as three-quarters of Medicaid spending. As a result, there is no way that the program can shrink by 25 percent (as under the AHCA) or almost 50 percent (as under the Trump budget), without hurting these people.

Finally, these cuts would just shift costs to the rest of the government. Lower-quality nursing home care leads to more hospitalizations, and for Americans over 65, these are paid for by another government program, Medicare. One-quarter of nursing home residents are hospitalized each year, and the daily cost of caring for them more than quadruples when they move to the hospital.

Trump and the Republicans would like most Americans to believe that these cuts will not affect them, only their "undeserving" neighbors. But that hides the truth that draconian cuts to Medicaid affect all of our families.

David Grabowski is a professor of health care policy at Harvard Medical School. Jonathan Gruber is a professor of economics at MIT. Vincent Mor is a professor of health care policy at Brown. © 2017 New York Times

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