Government, doctor or patient -- whose health care preferences should be honored?
Senate budget just the latest attack on seniors
Long-term care advocates breathed a sigh of relief when the latest Senate Republican attack upon seniors, the Graham-Cassidy bill, died. Under the guise of Affordable Care Act repeal, and replacement, Graham-Cassidy would have decimated traditional Medicaid care.
Yet that threat looms again, in the form of the U.S. Senate-passed budget. And unlike the failed health care bills, this time even Republican "moderates," like Maine Sen. Susan Collins, joined in the attack. Not only is the Senate budget even worse in its impact upon Medicaid, but it also cuts Medicare in order to pay for tax reform. According to one analysis, the cuts are at least $1 trillion for Medicaid over a decade's time and $473 billion for Medicare.
The impact is unmistakable. As Sen. Angus King (I-Maine) noted during floor debate, "If you are cutting Medicare, you are hitting seniors." Furthermore, "70 percent of the nursing home beds in America are paid for by Medicaid. By definition, who is in those beds? Seniors."
As was true during debate over Graham-Cassidy and its failed predecessors, Republicans characterize cuts as just a reduction in increases. Sen. Cory Gardner (R-Colo.) went so far as to invoke a child who grows two inches compared to a projected four, asking, "[D]id he shrink? No. He still grew." More confusingly, Senate Budget Chairman Mike Enzi (R-Wy.) claimed "Medicaid outcomes" were "lackluster" as his excuse for cuts.
Gardner's strange analogy fails to acknowledge simple demographic truths. According to the Census Bureau, by 2030 there will be 3 million more Americans 85-and-older than there were in 2012. This is a demographic where one commonly has long-term care needs, and has exhausted resources to pay for care. If the elderly population has substantially grown, while funding for it has substantially decreased, how has a cut not occurred? And what "outcomes" would Enzi then predict?
Following the Senate vote, President Trump crowed on Twitter that it was a "first step toward delivering MASSIVE tax cuts for the American people!"
The president has long-forgotten his numerous, explicit campaign promises to protect Medicaid and Medicare. In 2015, for example, he advertised himself on Twitter as "the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid."
The road to tax reform is apparently paved with broken promises and human suffering. And its proponents have been candid about that tradeoff, as the U.S. Chamber of Commerce was in a letter supporting cuts to fund tax breaks: "Federal entitlement spending is on an unsustainable path, ultimately harming the economy and America's long-term prosperity."
Yet what, exactly, is unsustainable - beyond the unavoidable reality of an aging population? Medicaid funding for nursing homes, according to federal government analysis, had a projected 1.6 percent decrease in 2016. For this year funding was projected to rise just .4 percent.
By 2025 Medicaid spending for nursing home care is projected to only be $16.8 billion more than it is this year. In contrast, the cost for Chamber member Lockheed-Martin's F-35 fighter jet program is now an estimated $406.5 billion. The Iraq War cost taxpayers well over $2 trillion.
As this latest attack on seniors unfolds, funding for the Children's Health Insurance Program, serving 9 million kids, has lapsed since congressional failure to reauthorize it by Sept. 30, as did funding for community health centers. Perhaps soon all of America's most vulnerable citizens will suffer, largely to free up more resources for the nation's wealthiest one percent.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association, which represents 90 long-term care facilities. Williams is also an attorney, former Washington state deputy insurance commissioner and former Washington state representative.