Medicaid a Big Deal Too

May 25, 2011 8:02 p.m.

Medicare gets all the attention, for a lot of good reasons. But as TPM Reader KH argues the cuts to Medicaid are no less devastating, though most people don’t figure it will ever directly affect them …

I’m seeing little on what I think is one of the most devastating proposed results of the Ryan budget bill, if it ever was put into law, and one that has the potential to be just as powerful as the “Turn Medicare into a voucher program” part, if and when people ever begin to see what the Medicaid cuts mean. Most middle-income people have no idea the impact of the Medicaid cuts. They assume those have no direct results on them.

It’s the part about turning Medicaid into flat-amount Block grants. Most people go right on by that part – “it’s poor people, has nothing to do with me, so we’ll cut dental and podiatry and vision coverage, etc. for poor people (as California Medi-CalMedicaid did a year or two back). That’s too bad, terrible, but we’ll save lots of money.”

But actually, as the link shows, Medicaid pays the bill for 66% of all nursing home residents. And these aren’t the indigent – mostmany of them are the result of middle-income people who have already run through their own money paying for their nursing home costs, and then become eligible for Medicaid. If Medicaid doesn’t pick that up anymore, who’s left? The children of the residents? Who are trying to send their kids to college and saving for their own retirement? Not that Paul Ryan cares, but essentially, states will need to choose between basic healthcare for low-income people and nursing home care for formerly-middle-income people with no money left. Who wins, you think?

Most people have no awareness that Medicare pays nothing for basic Nursing Home care. Most of the family members don’t necessarily know – just the one poor sondaughter who is “taking care ofmanaging” the parent’s finances.

You think people get worked up over the proposed Medicare changes? Imagine their reaction when they learn (too late?) that the Medicaid changes Paul Ryan and the Republicans want to make would mean they have to pay several hundreds of dollars a day to keep their parents in the nursing home they have been in for monthsyears?

My mother, who eventually developed dementia (sort of like Alzheimer’s but with no awareness of it), was in a Nursing Home for years. But, having had to deal with it when her mother developed it back in the 1960’s, and having the great fortune to have worked for a large employer who offered Long Term Care Insurance many years ago (when almost no company did), she realized the importance of it and signed up immediately. Though she came close, she never had to apply for Medicaid. Her insurance paid for it. The exception, not the rule, I’m afraid, even today.

My point is – we (well, most of us) all “get” how threatening the “voucher” change is for Medicare, but people don’t seem to see the danger of the Medicaid “Block Grant” change is to middle-income people in their 30’s, 40’s and 50’s who have elderly parents who could losenever be eligible for their Medicaid Nursing Home coverage. They just see “Medicaid” and assume it has nothing to do with them.

Are we really going to devolve into that sort of country? How sad. And how sad that so many Republicans are determined to make it happen. Hopefully, the reality will wake up the people who can make the difference, as it did in 2008.

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