Romney’s Medicaid cuts would be devastating to nursing home care and the disabled

Posted by AzBlueMeanie:

During his DNC Convention speech, former president Bill Clinton raised a subject that had been largely ignored by the media until then — the Romney/Ryan proposed cuts to Medicaid that would immeidately affect many seniors on Medicare (the "dual eligibles"). DNC 2012: Bill Clinton’s speech at the Democratic National Convention (Full transcript):

Now, folks, this is serious, because it gets worse. And you won’t be laughing when I finish telling you this. They also want to block grant Medicaid and cut it by a third over the coming 10 years. Of course, that’s going to really hurt a lot of poor kids. But that’s not all. A lot of folks don’t know it, but nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid. It’s going to end Medicare as we know it. And a lot of that money is also spent to help people with disabilities, including a lot of middle-class families whose kids have Down’s syndrome or autism or other severe conditions. And, honestly, just think about it. If that happens, I don’t know what those families are going to do. So I know what I’m going to do: I’m going to do everything I can to see that it doesn’t happen. We can’t let it happen. We can’t.

As everyone knows by now, Clinton departed from his prepared text and was winging it for much of his speech. Sarah Kliff at Ezra Klein's Wonkblog at the Washington Post fact-checked this portion of Clinton's speech, and found that his prepared text on this subject was accurate. Fact-checking Bill Clinton on Medicare:

Lots of folks don’t know this fact… because it’s not true. Clinton here is referring to the 9.1 million seniors who are low-income or disabled, making them eligible for both entitlement programs. In health wonk terminology, they’re referred to as the “dual eligibles.”

Dual eligibles certainly cost more than other Medicaid enrollees, like children and pregnant women. But there’s no evidence to support that these patients eat up two-thirds of the Medicaid budget. Kaiser Family Foundation looked at this issue in an April 2012 brief. It found that, “Although these ‘dual eligibles’ accounted for only 15 percent of Medicaid enrollment in 2008, 39 percent of all Medicaid expenditures for medical services were made on their behalf.”

Clinton’s prepared remarks on this point, however, were quite different. Here’s how those went: “Almost two-thirds of Medicaid is spent on nursing home care for seniors and on people with disabilities, including kids from middle class families, with special needs like, Downs syndrome or Autism.” That checks out: the Congressional Budget Office estimates that 63.5 percent – or $148 billion – of federal Medicaid spending ($251 billion in total) goes towards the elderly, blind and disabled.

Bloomberg News last week looked at this issue and found Medicaid to Lose $1.26 Trillion Under Romney Block Grant – Bloomberg:

Republican presidential nominee Mitt Romney would strip Medicaid of $1.26 trillion over nine years as part of a plan to do away with the open-ended approach to funding the U.S. health-insurance plan for the poor, a Bloomberg Government study found.

Romney proposes to convert Medicaid to a fixed allotment of money from an entitlement tied to economic indicators and a state’s caseload. Payments from the federal government would grow at 1 percentage point above inflation a year, creating the funding reduction, in exchange for fewer rules on how states use the money, according to the study released yesterday.

The Medicaid proposal has drawn less attention in the campaign than Romney’s ideas for Medicare, the U.S. health plan for the elderly and disabled. The Medicaid plan could be implemented as soon as 2014 and involves more money. Romney has said Medicare beneficiaries wouldn’t face changes until 2022.

“The impact on our nation’s low-income children, people with disabilities, and seniors would be devastating,” said Bruce Lesley, president of First Focus, Washington-based group that concentrates on children’s issues, and a former aide to Senate Democrats. Losing $1.2 trillion “will eliminate coverage for millions of people, reduce access to necessary care and create a system of health rationing.”

Medicaid covered about 62 million Americans in fiscal 2009, according to the Kaiser Family Foundation, a Menlo Park, California-based research group. About 49 percent of enrollees were children. It is a joint federal-state program.

The Romney campaign cooperated with the study’s author, Bloomberg Government analyst Christopher Flavelle, providing access to a Romney adviser who discussed some of the health proposals, on condition that the person not be identified.

* * *

If Medicaid funding cuts were distributed according to health industries’ current exposure to the program, home health agencies and nursing homes would face the steepest reductions as a proportion of their revenue, Flavelle found.

My neighbor of limited financial means, whose mother is in nursing home care for Alzheimer's disease, would be financially ruined. My neighbor of limited financial means, whose child has Downs syndrome, would be financially ruined. And my neighbor of limited financial means, whose spouse recently died after home hospice care, would be financially ruined if these policies were in place. These are not just numbers on a balance sheet, these are real people who could be left destitute by the real-life consequences of massive cuts to Medicaid programs.

We are a better nation than this. Caring for a child with a disability or end of life medical care should not leave a family financially destitute.

UPDATE: Sarah Kliff at Ezra Klein's Wonkblog today, Romney’s health care plans don’t exempt today’s seniors:

It has been a central campaign promise from Mitt Romney: His Medicare
overhaul plan would not touch benefits for anyone older than 55.

That may not, however, be the case with the Republican presidential
nominee’s other health-care proposals. A growing body of research
suggests that his plans to repeal the Affordable Care Act and cut
Medicaid funding would have a direct impact on the health care that
seniors receive.

Repealing the health law would mean higher Medicare premiums, the Kaiser Family Foundation found
in a recent analysis. Wellness visits and prescription drugs also would
cost more. Although under the current law, reductions in doctor
payments could create an access issue.

The impact could be greatest for the lowest-income seniors, who
qualify for both the Medicare and Medicaid programs, and there could be a
significant slowdown in federal funds available for their care.

* * *

[A]nalysts say that out-of-pocket spending by seniors would increase if
the Affordable Care Act is repealed. “On average, spending for seniors
would rise because their premiums would rise,” Neuman said.

* * *

The health-care law . . . gradually eliminates the
doughnut hole over the course of a decade. This saved seniors who fell
in the doughnut hole an average of $643, according to a Health and Human
Services analysis.

All that extra drug coverage, however, does come with a cost. In
order to foot the cost of closing the doughnut hole, seniors had to
spend $2 more on prescription drug premiums in 2012 than they would have
without the health law. By 2021, they will pay $33 annually to cover
this new benefit’s costs.

The biggest change, however, may not be in Medicare at all. It could
result from Romney’s planned spending reductions for approximately 6 million low-income seniors eligible for both the Medicare and Medicaid programs.

“Seniors can survive with the changes to the Affordable Care Act,”
said David Cutler, a health economist at Harvard University who has
advised the Obama administration on health policy. “No one is going to
claim that’s the end of the word. The Medicaid cuts have the potential
to be really, really bad for seniors.”

* * *

These seniors, usually referred to as “dual eligibles,” tend to have expensive health-care needs, accounting for 20 percent of Medicaid’s $251 billion in spending last year.

The Romney budget would reduce Medicaid spending on current
beneficiaries by more than $600 billion over the next decade, according
to a recent Bloomberg Government analysis.