Plan on Growing Old? Then the Medicaid Debate Affects You

All too many of the currently comfortable are utterly unconscious of this fact, for reasons that are perfectly understandable. We assume, incorrectly, that Medicaid is only for the younger poor or those with disabilities and that Medicare will pay for most nursing home care. Emotionally, we just cannot handle the prospect of our breaking down in old age. So we put our heads in the sand.

Reality forces our hand, however, when the first nursing home bills arrive. The average annual cost is $82,128 for a semiprivate room, according to Genworth, which sells insurance that can help pay those bills. Most people can’t pay that amount and certainly not for long, especially after 10 or 20 years of retirement spending. If a spouse (a male spouse, more often than not in heterosexual couples) has already needed years of expensive care, the other partner is all the more vulnerable.

Ask around. Someone you know has quietly faced these facts and probably turned to Medicaid. Chances are, you, a family member or a close friend will someday, too.

So we tune out the health care policy debates at our own peril. The proposed cutbacks in the growth of Medicaid spending do not just affect the expansion that has taken place in recent years. They propose new per-capita caps on spending.

While the haggling over the calculations continues, it is hard to predict or quantify how painful the cuts will be for seniors compared with children and adults who are poor or have disabilities. Each state will have some discretion over which of its populations bear the brunt of any cuts. The Congressional Budget Office did suggest on Thursday that Medicaid’s budget could be 35 percent lower by 2036 if the Senate’s most recent proposal were to take effect, rather than if the status quo remained.

So if anything like the proposed cuts come to pass, the impact will be meaningful. In addition to nursing homes, Medicaid may also pay for home- and community-based care for older adults, and H. Stephen Kaye, the director of the Community Living Policy Center at the University of California, San Francisco, recently examined how much less might have been budgeted for those services and others for people with physical and other nondevelopmental disabilities if the House bill’s caps had been in existence from 2001 to 2013. His estimate? Roughly 25 percent, a staggering figure for people who use those services to keep themselves out of nursing homes in the…

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