Mon Sep 24, 2012, 01:25 AM
davidn3600 (1,288 posts)
Romney's lean, mean Medicaid plans for nursing home residents
As the presidential campaign unfolds, the differences in approaches to Medicare by President Barack Obama and Republican nominee Mitt Romney have taken center stage. But what is getting far less scrutiny: Romney's plans for Medicaid. He would convert the health care program for the poor, disabled and elderly into a block grant to the states and sharply reduce funding over time. Middle-class Americans should be especially wary, since it's Medicaid, not Medicare, that covers nursing home care for aged and infirm parents and grandparents. Without Medicaid's safety net, it isn't clear what those Americans would do, and Romney doesn't have any good answers.
It's an understandable confusion. People think that since Medicare covers medical services for people over 65, it also pays for nursing home care for elderly people. Medicaid is thought of as a poverty program that provides medical coverage to poor families. But Medicaid is the program that provides long-term care to the elderly and disabled, which accounts for 31 percent of the program's $400 billion annual federal and state spending. Most of the nation's 1.8 million nursing home residents, including more than 77,000 Floridians, rely on Medicaid to pay their bills.
Medicaid's nursing home beneficiaries are not necessarily poor people. During their working years they may have lived productive middle-class lives until becoming infirm and quickly exhausting their assets. No matter how assiduously families save for retirement, there aren't many who could long afford the steep costs of a residential nursing home that can run an average of $80,000 a year. Without Medicaid's essential safety net, members of this vulnerable population would be on their own or might be forced to live with relatives ill equipped to care for their intensive needs.
There is an irony to Romney running mate Paul Ryan's applause line at the Republican National Convention last month that "the truest measure of any society is how it treats those who cannot defend or care for themselves." It was Ryan who authored the plan to convert Medicaid from a strong federal-state entitlement to a block grant program to the states that Romney has incorporated into his campaign. The plan, passed as a budget blueprint by the Republican-controlled House, would gut Medicaid's safety net and focus instead on cutting funds. The nonprofit Center for Budget and Policy Priorities says Medicaid funding would decline by one-third by 2022 under Ryan's plan.
7 replies, 837 views
Romney's lean, mean Medicaid plans for nursing home residents (Original post)
Response to davidn3600 (Original post)
Mon Sep 24, 2012, 01:48 AM
exboyfil (3,399 posts)
1. This is the issue that turned me from a Libertarian to a
Democrat. Five years ago my grandmother came under my financial care when my aunt could no longer care for her (both of her other children including my mom did not step up to the plate). I arranged to have my grandmother placed in a wonderful nursing home under Title 19 and protected her life savings in the form of a bank account by setting up a funeral fund for her (still not enough for the funeral but a start).
Medicaid has probably spent close to $500K for her care since going into Title 19 (Medicare). The family in no way could have afforded this expense otherwise.
What is little understood is that many states have filial responsibility laws. Such laws require immediate family members to cover the cost of charity for their parents or in some cases their grandparents. These laws are what keeps me up late at night worrying. If they are applied in my grandmother's case, we will have to bring her home to a 2 story house without a ground floor shower. She needs assitance from two people to do anything - she cannot move on her own (no control of arms or legs).
In Pennsylvania recently filial responsibility was applied in a case. Anytime a Republican talks about reducing/eliminating this area of the budget, they should be asked about these laws and whether they feel the states then should go after families to cover these expenses. That should be a debate question even.
Ultimately I am not sure if the country has the wealth necessary to operate like it continues to do regarding nursing home care. This expense is only going to go up dramatically (especially if CNAs get paid what they deserve to get paid). It is a serious question that is not being talked about in an adult fashion by either party.
Response to exboyfil (Reply #1)
Mon Sep 24, 2012, 04:22 AM
BlueCollar (3,504 posts)
2. So what's the answer?
You are right when you stated...
"Ultimately I am not sure if the country has the wealth necessary to operate like it continues to do regarding nursing home care. This expense is only going to go up dramatically (especially if CNAs get paid what they deserve to get paid). It is a serious question that is not being talked about in an adult fashion by either party."
In my opinion the answer lies in looking at how the rest of the developed world does it. I'm not an expert but I'm guessing something along the lines of single-payer is the most likely. Take the entire working population and the per-capita cost decreases significantly.
Response to BlueCollar (Reply #2)
Mon Sep 24, 2012, 08:07 AM
exboyfil (3,399 posts)
6. I would advocate the German model
as a start, but even European countries are feeling the crunch (and they don't spend 4.7% of their GDP on defense (usually halft that) and 50% more on a per capita basis on health care) that we do.
Response to davidn3600 (Original post)
Mon Sep 24, 2012, 04:28 AM
Iris (13,879 posts)
4. it isn't clear what those Americans would do, and Romney doesn't have any good answers.
Here's an answer: How about women stay home where they belong? They should marry at 18 or 22, depending on whether or not their families can send them to college...er....finishing school. Have 2.3 kids. Raise them. Then take in the in-laws and her own parents as they become infirm. In the meantime, her husband can work himself to death in order to provide enough money to provide for them all.
It's a great plan. 50% of the 99% out of the workforce leaves that much more money for the 1% to grub up.
Response to littlemissmartypants (Reply #5)
Mon Sep 24, 2012, 12:09 PM
barbtries (15,013 posts)
7. who are probably collecting welfare
and dependent children benefits since the state does not recognize their "marriage."
bleeding the beast - that's the FLDS way.