Tax win will embolden GOP to gut health care for the most in need

With the Senate having passed its budget-busting tax plan, the means of offsetting its $1.4 trillion addition to the federal debt is coming into focus.

Senate Finance Chairman Orrin Hatch (R-Utah) has groused about the poor, in the context of the long-delayed renewal of the Children’s Health Insurance Program: “I have a rough time wanting to spend billions and billions and trillions of dollars to help people who won’t help themselves — won’t lift a finger — and expect the federal government to do everything.”

{mosads}That might include CHIP, as passage of Hatch’s tax plan means, he admits, “we don’t have money anymore.”

President Trump, having long ago abandoned his campaign promises to not cut the safety net, has similarly complained that poor “people are taking advantage of the system.” During Senate tax debate, a motion from Sen. Bernie Sanders (I-Vt.) was defeated that would have created “a point of order against legislation that cuts Social Security, Medicare, or Medicaid benefits.”

As Sen. Richard Durbin (D-Ill.) had asked, “Are you ready to see Medicaid, which has as its major expense taking care of seniors in nursing homes — benefits cut in order to give an incentive for businesses to move jobs overseas?” The answer was evidently “yes.”

Sen. Chuck Grassley (R-Iowa), Hatch’s predecessor as Republicans’ Finance lead, has also been candid in stating his priorities. Defending the reduction of the estate tax, he suggested that individuals who don’t accrue $11 million estates, which would now go untaxed, “are just spending every darn penny they have, whether it’s on booze or women or movies.” While I can’t vouch for what’s happened to Iowa since Grassley addressed my Iowa City High civics class, I can address issues affecting Medicaid care.

Those in Medicaid long-term care have, indeed, spent “every darn penny they have” — principally on the costs of aging and infirmity. A George Washington University study in 2015 found the average health care costs for those 65-and-older exceeded $10,000 a year — over 250 percent more than the average for those under 65. And those paying out-of-pocket for long-term care can quickly exhaust resources, paying an average of $21,840 for in-home care, or almost twice that to reside in an assisted living facility, where poor rates make Medicaid an uncommon option in many states. They don’t have resources to spare for frivolities. 

Nor do their caregivers. Medicaid spending, which pays for much of long-term care, went up only 1.7 percent at the federal level last year, and depresses compensation for caregivers in home-and-community-based settings and nursing homes.

According to one study, 89 percent of home care workers are women. Though government provides 72 percent of the funding for the home care sector, predominantly through Medicaid, over half of the workers must rely upon public assistance themselves because their wages are so inadequate. Ironically, over one-quarter of these workers are themselves on Medicaid. Are they “taking advantage” in accessing health care while providing it? 

In nursing homes, 85 percent of the workers are reportedly women. Poor Medicaid reimbursement means many, often single moms, must work overtime or second jobs to support their children. Those that they care for are largely, as a function of demographics, elderly women. Those 85-and-older, the rapidly-growing demographic most in need of assistance with the activities of daily living, are two-thirds women. Altogether, the latest data shows 8.3 million seniors are being served by both Medicare and Medicaid.

Those providing long-term care, and those being cared for, are a largely invisible demographic. We don’t like to confront our mortality, or the infirmities associated with aging. Certainly, nursing home caregivers can’t rally in Washington, D.C., or buy their way into the closed-door meetings where tax breaks are hatched. But consider this: The reduction in the estate tax alone will, each year, exceed the anticipated federal growth in Medicaid costs.  

By 2027, the $83 million revenue loss projected from 2018-27 from the estate tax cut would exceed the $48.1 growth projected in federal Medicaid expenditures for nursing home care over that time, even though Hatch asserts Medicaid “is bankrupting both state and federal governments.” Would we rather the ultra-wealthy pass their estates on untaxed, or would we rather the elderly age with some dignity?

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.