My question to you is "Where are they all going to go?" Homeless? or are we going to set up firing squads to deal with them? OR are we going to make them live with their kids like people do in other countries? What if they don't have any kids or their kids are in nursing homes too. Do they all just live on the streets together then?
Trump's Republican party has no idea what kind of hornet's nest they have stirred up this time! Good luck Republican party in 2018. How are you going to Spin this?
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ORANGE, Va. — Alice Jacobs, 90, once owned a factory and horses. She has raised four children and …
ORANGE, Va. — Alice Jacobs, 90, once owned a factory and horses. She has raised four children and buried two husbands.
But years in an assisted living center drained her savings, and now she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home here.
“You think you’ve got enough money to last all your life, and here I am,” Ms. Jacobs said.
Medicaid pays for most of the 1.4 million people in nursing homes, like Ms. Jacobs. It covers 20 percent of all Americans and 40 percent of poor adults.
On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid,
part of the effort to repeal the Affordable Care Act. Conservatives
hope to roll back what they see as an expanding and costly entitlement.
But little has been said about what would happen to older Americans in
nursing homes if the cuts took effect.
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Under
federal law, state Medicaid programs are required to cover nursing home
care. But state officials decide how much to pay facilities, and states
under budgetary pressure could decrease the amount they are willing to
pay or restrict eligibility for coverage.
“The
states are going to make it harder to qualify medically for needing
nursing home care,” predicted Toby S. Edelman, a senior policy attorney
at the Center for Medicare Advocacy. “They’d have to be more disabled
before they qualify for Medicaid assistance.”
States
might allow nursing homes to require residents’ families to pay for a
portion of their care, she added. Officials could also limit the types
of services and days of nursing home care they pay for, as Medicare already does.
The
150 residents of Dogwood Village include former teachers, farmers,
doctors, lawyers, stay-at-home parents and health aides — a cross
section of this rural county a half-hour northeast of Charlottesville.
Many entered old age solidly middle class but turned to Medicaid, which
was once thought of as a government program exclusively for the poor,
after exhausting their insurance and assets.
A
combination of longer life spans and spiraling health care costs has
left an estimated 64 percent of the Americans in nursing homes dependent
on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the
primary payer for three-quarters or more of nursing home residents in
2015, according to the Kaiser Family Foundation.
“People
are simply outliving their relatives and their resources, and
fortunately, Medicaid has been there,” said Mark Parkinson, the
president of the American Health Care Association, a national nursing
home industry group.
With
more than 70 million people enrolled in Medicaid, the program certainly
faces long-term financial challenges. Federal Medicaid spending is
projected to grow 6 percent a year on average, rising to $650 billion in
2027 from $389 billion this year, according to the Congressional Budget Office.
Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.
“The
Medicaid pieces of the House bill could be incorporated into other
pieces of legislation that are moving this year,” said Edwin Park, a
vice president at the Center on Budget and Policy Priorities, a
Washington nonprofit that focuses on how government budgets affect
low-income people. “Certainly, nursing homes would be part of those
cuts, not only in reimbursement rates but in reductions in eligibility
for nursing home care.”
While
most Medicaid enrollees are children, pregnant women and nonelderly
adults, long-term services such as nursing homes account for 42 percent
of all Medicaid spending — even though only 6 percent of Medicaid
enrollees use them.
“Moms
and kids aren’t where the money is,” said Damon Terzaghi, a senior
director at the National Association of States United for Aging and
Disabilities, a group representing state agencies that manage programs
for these populations or advocate on their behalf. “If you’re going to
cut that much money out, it’s going to be coming from older people and
people with disabilities.”
The
House health care bill targets nursing home coverage directly by
requiring every state to count home equity above $560,000 in determining
Medicaid eligibility. That would make eligibility rules tougher in 10
states — mostly ones with expensive real estate markets, including
California, Massachusetts and New York — as well as in the District of
Columbia, according to an analysis by the Center for Budget and Policy
Priorities.
Dogwood
Village receives about half of its $13 million annual operating costs
from Medicaid, with rates from $168 to $170 a day. Some residents who
come to the nursing home after a hospital stay are initially covered by
Medicare, but if they stay longer than 100 days, that benefit ends, and
those without savings move to Medicaid.
“You
have patients who have spent their life savings, and they come here,”
said Kristen Smith, the admissions coordinator. Ms. Smith said patients
now are older and sicker than they used to be, frequently arriving
directly from a hospital.
“It
used to be hips and knee” surgeries, she said. “And now a lot of those
patients are going home. What we’re seeing is more complex, sicker
patients.”
With
cinder-block walls brightened by pictures of horses that evoke this
equestrian county, the nursing home offers crafts, bingo and other
activities.
Mary
Ann Mohrmann is 85, the average age of Dogwood Village residents. An
elementary schoolteacher for 25 years, she has Charcot-Marie-Tooth
disease, a neurological disorder that has weakened her legs, feet and
thumbs and compromised her fine motor skills.
Two
of her children have it, too, she said. None of them can take care of
her at home. “I’ve been here years,” she said. “I don’t know how many.”
Medicaid
helps pay for care for people with disabilities, like Nancy
Huffstickler, 65, who has been here for four years and regards herself
as “a medical disaster.”
She listed her ailments: spinal cancer in remission, restless leg syndrome, high blood pressure and multiple ulcers. She has had spinal reconstructive surgery and a hip replacement. She is undergoing physical therapy with the hope that one day she will be able to leave her wheelchair and use a walker.
Ms.
Huffstickler is fearful of Republicans’ health care changes. “It may
save the federal government money, but what about us?” she asked.
Major
Medicaid cuts would compel Dogwood Village to cut staff, supplies and
amenities — changes that would affect the quality of care for all
residents, not just those on Medicaid.
If
that does not save enough money, the nursing home might have to reduce
the number of Medicaid residents, said Vernon Baker, who resigned as
administrator in April. “It’s not like our toilet paper or paper towels
are like the Ritz-Carlton’s,” he said.
Some
residents do not even know they are on government insurance;
administrators often complete the paperwork to start Medicaid once other
insurance expires. Others are embarrassed that they are dependent on a
program that still carries stigma.
They
should not be, said Jennifer Harper, the assistant director of nursing.
Relying on Medicaid for nursing home care has become the new normal.
“These
folks have worked their whole lives, some with pretty strenuous jobs,
and paid into the system,” she said. But with changes looming, she said,
“it may be a system that fails them.”
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