What's the greatest threat to American health care? Republican leaders in Congress seem to think it is large numbers of America's grandparents.
The Republican health care bills in both the House and Senate would devastate Medicaid, and the frail elderly benefit more from Medicaid than almost any other group. The program devotes more than 30% of its budget nationwide to long-term nursing home care for the elderly and disabled, and it covers almost two-thirds of the country's cost of providing it.
Without Medicaid, few people at any income level could afford a long-term stay in a nursing home, which can cost as much as $90,000 a year. If the program were eliminated or cut substantially, many nursing homes would be forced to close and many residents would have nowhere to go.
You probably know someone who relies on Medicaid for long-term care. It might be a grandparent, parent, uncle or aunt. If it is not your relative, there is almost certainly an elderly relative of someone you know who needs Medicaid to get by. Many of them have spent down their assets to qualify, because Medicare, which covers all elderly regardless of income, does not cover extended long-term care.
And someday, it could be you. Forty percent of Americans will eventually need nursing home care.
The Republican bills are touted as ways to "fix" Obamacare's problems, which supporters see as rampant in the individual insurance markets that the law created. But the most significant aspect of both bills has nothing to do with insurance markets. It is the dramatic cuts to Medicaid that would throw millions of people off the rolls.
Under the Senate bill, 15 million people would lose health insurance by next year and 22 million within ten years, most by losing eligibility for Medicaid. The bill would impose a per-person cap on Medicaid funding to the states, which would force them to limit care to those who generate the greatest costs. The frail elderly, as one of the most expensive groups, would almost certainly bear the brunt.
Where would the savings go? Would they address other health care needs? To the contrary, they would fund a huge tax cut, 40% of which would benefit those making close to a million dollars a year or more.
Not all Republicans support these bills, and some have even denounced them. But the party's leadership is pushing ahead aggressively with the backing of most rank-and-file members in both houses of Congress.
Do supporters of these bills truly consider caring for millions of frail elderly to be a problem that needs to be fixed? And do they actually think that throwing residents out of nursing homes is the way to fix it?
Some would say that funneling money to millionaires at the expense of frail elderly patients is morally suspect. Others would put it in much stronger terms.