Medicaid affects us all
My dad, a veteran and retired postal worker, collapsed on his living room floor in 2007 when he was 55 years old. He was on the floor for three days before anyone found him. After spending a month in the Veterans Administration (VA) hospital in Indianapolis, he was eventually transferred to a nursing home and that’s where he has been since. He is covered by Medicaid in Indiana (and now, also by Medicare) — not by private insurance, and not by the VA. Suffice it to say, his existence is not one I would wish on anyone.
My uncle, who lives in Delaware and is afflicted by the same medical condition, lives a very active life. He swims regularly at the YMCA, keeps active with his church community, uses the paratransit service to get around in his wheelchair, and until recently, only had Medicare for insurance, so he did not have the appropriate level of community-based care. He had several falls, resulting in multiple hospital and rehab stays, ambulance trips, and therapy. He was terrified of ending up in a nursing home like my dad, which he saw as being the end of his life as he knew it. He applied for Medicaid’s Home and Community Based Waiver program in Delaware, which is a flexibility that varies by state, and is an option that lets people receive services in their home instead of a nursing home because it is cheaper for the government and preferable for the individual.
Today, my uncle is healthy and happy and competed in Delaware’s Senior Olympics swimming events again last October. He costs the state and federal government far less money when he doesn’t fall and is receiving a small amount of services to keep him healthy. Medicaid pays for 51% of the country’s long-term services and supports, which is how we refer to nursing home care and the care that people receive in their homes like my uncle. A lot of people don’t realize that Medicaid pays for most nursing home care — not Medicare.
I work for a company that was founded, in part, based on how Medi-Cal, California’s Medicaid program, helped one of our company’s founders stay in the middle class, go to college, work at Google, and start a company. Her family stayed out of medical bankruptcy and cared for her severely disabled brother at home. Nuna, the company, means “big sister” in Korean, which is one of the few words he can say.
My niece and nephew were both born on Medicaid, in two different states. Their moms each had pre- and postnatal visits paid for and the birth was covered as well. Medicaid also covered the children for a year after the birth so that the vaccination schedule was covered, as well as the doctor visits for the well-child check-ups. Longitudinal data shows that disadvantaged children who had Medicaid coverage versus children who did not were healthier adults, with greater academic success, and greater economic opportunities. 50% of the nation’s births are paid for through Medicaid, including about 40% of the pre-term births.
While Medicaid helps people like my family and my colleague’s brother, it’s not just about the consumer; it’s about the caregivers and families too. We all need to live fulfilled lives and for some people, that means caring for an elderly or disabled loved one. But for others, that means pursuing something else, or caring for different loved ones, like children. For these people, the Medicaid program has been a lifesaver providing respite (services that provide relief when a caregiver needs a break), home health, nurses, meals on wheels, and other people trained to do lifting and bathing patients for their loved ones. With our aging Baby Boomer population and the role Medicaid plays in financing long-term care services, now is not the time to threaten the economic viability of this critical safety net program.
The nonpartisan Congressional Budget Office predicts that the AHCA will reduce federal Medicaid spending by $880 billion over the next ten years. As a point of comparison, 2015 federal Medicaid expenditures was approximately $550 billion, so this is clearly a massive reduction. The CBO predicts that 14 million people will drop out of the Medicaid program over the next 10 years if this law is passed.
The Trump Administration officials, including Health and Human Services Secretary Tom Price, have said that there will not be cuts to the Medicaid program, but rather changes that let states be more flexible to the needs of their constituents. The Secretary already issued a letter to the governors detailing what those changes may include things like: requiring people to work in order to maintain their Medicaid eligibility, requirements that people on Medicaid pay more for emergency room use, and increased contributions to monthly premiums. While these may sound like common sense approaches to some people, there are numerous reasons why research shows that they are actually costlier to implement and administer.
The existing section 1115 waiver structure (programs that let states experiment with the rules within Medicaid) already gives broad flexibility to the Administration. Their interest in the “block grants” and “per capita caps” — what they say they need in order to make these massive cuts to the Medicaid program — is really about ending the unlimited entitlements of the current Medicaid program, which means we will be having the same conversation about Medicaid that we are having about high-risk pools. Without an open-ended entitlement and with all the high-risk, Medicaid will never be able to serve all of the people who rely on the program for care — directly or indirectly. And that is all of us.
