Health bill could present nursing-home challenge
Updated 11:20 pm, Saturday, June 24, 2017
WASHINGTON — Deep cuts to Medicaid embodied in Senate and House versions of the GOP health care bill could sharply reduce critical payments to nursing homes, potentially leaving many middle-class families in Connecticut to foot the bill for elderly relatives.
Both bills envision ending Medicaid as an open-ended entitlement providing health insurance primarily for low-income families. Instead, federal Medicaid distributions would be capped.
The Congressional Budget Office estimated the formula in the House bill would eliminate more than $800 billion over the next decade.
Matthew Barrett, CEO of the Middletown-based Connecticut Association of Health Care Facilities, said the Republicans’ Obamacare “repeal-and-replace’’ measure would be a “catastrophe’’ for the state’s nursing home operators, as well as residents and their families.
“Medicaid for nursing homes is very much a middle-class benefit,’’ he said, noting it is the only national program that covers long-term care in a nursing home. “The common perception is that Medicaid is for somebody else, but it’s actually a program for all Americans.’’
More than 24,000 people are in Connecticut nursing homes.
Close to 70 percent of those are subsidized by Medicaid.
National rate is 62 percent.
Proposed cap would shift more financial burden to families.
Medicaid also can cover home and community health services.
Possible change of rules
In Connecticut, there are more than 24,000 mostly elderly nursing home residents, according to federal data compiled by the non-partisan Kaiser Family Foundation. Close to 70 percent of them are subsidized by Medicaid, which is funded through a combination of state and federal money. The national figure is 62 percent. Total Medicaid nursing-home expenditure in Connecticut topped $1.2 billion in 2016.
Connecticut’s rate of Medicaid-covered nursing-home residents is one of the higher ones in the nation. Only Alaska and deep-Southern states like Mississippi, Louisiana and Georgia have higher rates.
Connecticut’s aging population is on the rise, with a 51 percent increase in those over 65 projected by 2025.
Also on the rise is the incidence of difficult-to-manage conditions such as diabetes, Alzheimer’s and dementia, Barrett said.
To qualify for Medicaid, nursing home residents must first exhaust all their savings and assets, including the sale of homes. Once on the program, family members are not obligated to pay. But if the Republican bills become law, that might change.
U.S. Sen. Chris Murphy, D-Conn., a member of the Senate Health, Education, Labor & Pensions Committee and a bitter opponent of the GOP legislative effort, said the GOP measure would mean states like Connecticut ultimately have to ration nursing home care.
Doing so might end up throwing the financial burden onto families if they want loved ones to stay in these facilities, Murphy said.
“Medicaid is no longer a program for poor people; it probably touches an equal number of middle-class families,’’ he said in an interview Friday. “You’re not guaranteed that if Mom runs through her bank account that Medicaid will pick up the cost. That should freak out every son or daughter in this country.’’
A struggling state
Theoretically, cuts to the federal side of Medicaid financing could be offset by increased state spending. But such money is unlikely to flow from Hartford, which faces a projected $5 billion deficit over the next two years.
Medicaid payments to nursing homes are already insufficient, said Barrett. He calculated the shortfall at about $25 a day, per resident.
The GOP Senate bill in many ways is more moderate than the House counterpart. But it bends the downward cost curve of Medicaid over 10 years more radically by pegging it to the regular consumer price index, instead of more-generous medical inflation.
President Donald Trump praised the House bill after its passage, but then called it “mean’’ in a private session with Republican senators.
Trump had kind words for the Senate bill in a tweet: “I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, ObamaCare is dead.’’
The Republican effort to replace Obamacare with its own marketplace-based vision of health care is far from a done deal. Enough Senate conservatives have expressed opposition to put the bill’s passage through the Senate in jeopardy. The House passed its version last month.
On Friday, another Republican senator, Dean Heller, of Nevada, said he could not vote for the GOP Senate version. But unlike the conservatives, Heller’s opposition is based on fears the ultimate termination of Medicaid expansion — which under Obamacare provides insurance to those just above the poverty line — would hurt many of his constituents.
Even so, Senate Majority Leader Mitch McConnell, R-Ky., is haggling with recalcitrant Republicans and still hoping to get the bill passed by the Senate before the July 4 recess.