Is Tom Price the most dangerous man in America?
Although the appointment of Betsy DeVos as education secretary drew the most public opposition, the most dangerous Trump Administration appointee is easily Tom Price, the secretary of Health and Human Services.
Consider how many vulnerable lives lie under the purview of Secretary Price. Over 55 million Americans are on Medicare. Roughly another 74.5 million Americans receive health coverage through Medicaid or the Children’s Health Insurance Program. In other words, fully one-third of Americans receive healthcare through programs administered by Price.
{mosads} As House Budget Committee Chair, where he seemed largely focused on increasing the value of his healthcare stocks, Price made clear his contempt for the Medicaid program. State expenditures on Medicaid are matched by the federal government under a formula based on state incomes — poorer states get more, while more affluent states get less. In Congress, Price sought to replace this formula with care-rationing “block grants.”
The House-passed American Health Care Act (AHCA) would cut $839 billion from the Medicaid program over the next decade, according to impact estimates.
While much of the debate over the bill has centered on the Medicaid expansion that occurred under the Affordable Care Act, the reality is that cuts would affect funding that dates back to 1965. That longtime funding pays for more than 60 percent of nursing home residents, for example.
Price has falsely stated that Medicaid coverage wouldn’t suffer under the AHCA. In fact, huge cuts would occur by replacing matching funds with “caps” based on the number of Medicaid beneficiaries in each state.
These cuts would devastate long-term care, in particular. As Medicaid does not currently cover the costs of care in most states, underfunding has fueled a crisis in caregiver recruitment and retention. Excessive turnover affects the quality of care, which is held to a very high federal standard in nursing homes. Responsible nursing home providers will not admit patients where they lack sufficient staff, and home-and-community-based settings face staffing problems as well, resulting in a lack of access to care in many communities, particularly rural ones.
The United States is aging. According to one Census estimate, by 2050 the population of those 65-and-older will total 83.7 million — almost double what it was in 2012. Placing arbitrary limitations on the federal commitment to our aging population will only shift responsibility to state governments that, unlike the federal government, cannot engage in deficit-spending.
Inexorably a federal failure to match state spending, which Price euphemistically calls giving states “greater flexibility,” will cause a decline in the quality — and availability — of long-term care.
In a state like New Hampshire, which already has the nation’s second-oldest population, current state spending on Medicaid has created the nation’s third-worst gap between nursing home cost of care and Medicaid funding. That gap would only grow if there is no federal match to act as an incentive to improve the state commitment. In-home Medicaid care is beset also, and assisted living facilities receive only $49 daily for 24/7 care, meals and housing. Nor would federal cuts just affect seniors. Children with disabilities would suffer as well.
Rather than focus on his moral responsibility to the nation’s most vulnerable citizens, Price has sought to create what seems to be an authoritarian regime. In response to Price forbidding department staff from being responsive to members of Congress and their staffs, two key Republicans, Sen. Charles Grassley (R-Iowa) and Rep. Jason Chaffetz (R-Utah), sent a letter indicating Price’s policy was “potentially illegal and unconstitutional.”
Price later defended the arrest of a reporter who had the temerity to try to question him in West Virginia. The media, and public, were barred from a “listening session” he staged in New Hampshire.
In visiting with them the day after the House vote, it was clear caregivers and long-term care residents did not celebrate House passage of the American Health Care Act, as some Republican lawmakers did with beer blasts in marbled offices and a Rose Garden ceremony. Caregivers are utterly terrified of what comes next.
Price, in undoing half-century-old Medicaid protections, may yet be the architect of their dystopian future. It all makes one suspect Price, a physician, had his fingers crossed in taking the do-no-harm Hippocratic Oath. The Senate must resist his agenda.
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.
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