fresh voices from the front lines of change







How mean-spirited are Republican plans to repeal The Affordable Care Act?

Among other things, they will make states choose between kicking millions of old people out of nursing homes or kicking millions of poor and near-poor people off Medicaid health insurance.

This is one of the most pernicious effects of the Republican plan, and so far, it has been little reported in the media and hasn’t been discussed by the Democrats. It’s time for that to change.

Most people think of Medicaid as a program to provide health insurance to poor and near-poor people, to prevent them from dying in the streets or waiting until they’re really sick and going to emergency rooms where their mandatory care drives up costs for everyone else.

Nearly a quarter of the U.S. population, 70.5 million Americans, were were enrolled in Medicaid last year. Many or most of them otherwise couldn’t afford any health insurance. Along with Social Security and Medicare, Medicaid is one of the most effective and life-saving programs in American history.

But Medicaid is also something else. It pays for nursing home and other long-term care for millions of senior citizens and disabled people who can’t otherwise afford the average annual cost of  $91,250 for a nursing home or $45,800 for a home health aide.  It is estimated that 70 percent of people over 65 will need long-term care in their lifetime and Medicaid pays for 62.9 percent of nursing home residents.

In short, without sufficient Medicaid funding, millions of seniors would be thrown out on the street, unless their adult children quit their jobs to take care of them full-time.

Block Grants Kill

One of the aims of the Republicans’ plan to replace the Affordable Care Act is to cut Medicaid funding.

Right now, the Federal government pays states a substantial percentage of the Medicaid  costs for everyone who qualifies. The Republican plan wants to change that to “block grant” Medicaid payments to the states. In other words, each state would get a fixed amount per year, which amount would not increase as quickly as real health care and long-term care costs.

The result is that each year, states would have less money per Medicaid patient or nursing home resident, and the problem would get worse as the years roll on.  Unless states want to come up with the extra money themselves (and with state budgets already strained, this is unlikely) states would have no choice but to reduce the number of people qualifying for Medicaid.

State could do this by kicking poor and near-poor people off of Medicaid, leaving them without health insurance, or kicking old folks out of nursing homes. Most likely they’d have to do some of both.

It’s a brutal and inhumane choice. People will die, either because they can’t get the health care they need, or because in their old age they will have no one to take care of them.

There are many things that are inhumane in the proposed Republican repeal of the (admittedly imperfect) Affordable Care Act.  But cutting Medicaid spending through block granting is one of the most inhumane aspects of all.

The media, Democrats and the Resistance need to make clear that block granting Medicaid will force our states to make an unthinkable choice: kick grandma out of her nursing home, or kick poor and near-poor people off health care.

Is that really what people who voted for Trump were hoping for?

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