Trumpcare is officially known as the American Health Care Act, but that’s a lie. It isn’t a bill to provide health care, but exactly the opposite ― a bill to take health insurance away from tens of millions of Americans, especially those who are older, poorer, and sicker, in order to pay for massive tax giveaways for the wealthy and corporations. The bill cuts $880 billion from Medicaid, and cuts taxes primarily for rich people by about the same amount.
When people think of Medicaid, they don’t usually think “seniors.” But in fact, about six million seniors receiving Medicare are also enrolled in Medicaid ― and that number doesn’t include people in their fifties and early sixties, who will be increasingly likely to rely on Medicaid if Trumpcare passes and makes their premiums for private health insurance rise by 750 percent.
Medicaid is particularly important to seniors who require long term care and their families. That will be most of us one day: 70 percent of Americans ages 65 and older will eventually require long-term care services and supports, which include nursing facilities, home health aides, personal care, and family caregiving. Medicaid covers sixty percent of nursing home residents and forty percent of long term care services and supports.
Without Medicaid, millions of seniors and their families will not be able to afford long-term care. The median yearly cost for home health help is $46,000 per year, and for a nursing home it’s $92,000! In comparison, the average yearly Social Security benefit is only $14,776. Taking Medicaid benefits away from seniors forces their families (especially women) to provide at-home care even if they don’t have the time or skills to do so adequately. Those seniors who don’t have family members or friends who can take on care responsibilities are condemned to a lonely death.
Social Security Works has released a factsheet detailing the importance of Medicaid to seniors, through protections such as:
- Protection against high out-of-pocket costs. Medicaid helps to shoulder the burden of Medicare’s high out-of-pocket costs for seniors that live in or near poverty. For seniors living at or below the monthly federal poverty limit, Medicaid pays for Medicare premiums and cost sharing obligations. Medicaid also provides assistance in paying Medicare premiums for seniors living just above the poverty line (typically those with incomes of 100-120 percent of the federal poverty limit).
- Coverage of critical services. In addition to assisting low-income seniors with out-of-pocket healthcare costs, Medicaid provides coverage for a range of critical healthcare services that are not covered by Medicare. These services, which are especially vital to seniors, include prescription drugs, eyeglasses, and hearing aids. Medicaid ensures that seniors who already struggle to cover their basic costs of living do not have to forgo these important healthcare services.
- Long-Term care. The Centers for Medicare and Medicaid Services estimate that at least 70 percent of Americans ages 65 and older will one day need long-term care services and supports, which include nursing facilities, home health aides, personal care, and family caregiving. Because Medicare’s coverage of long-term care is extremely limited, and similar coverage under private insurance is typically unaffordable, seniors with chronic conditions who require assistance with daily living often exhaust their resources paying for long-term care services. For these seniors, Medicaid is often the insurer of last resort. Long-term care is one of Medicaid’s most critical, and invaluable, protections for our nation’s seniors. Indeed, one-fifth of Medicaid’s overall budget is spent on long term care.
- Nursing home services. In addition to covering long-term care, Medicaid provides critical coverage for seniors who rely on nursing home care. Such coverage is usually expensive, especially for seniors with limited means. Without Medicaid, seniors living in or near poverty would be forced to forego much-needed nursing home care.
The method that Trumpcare uses to gut Medicaid (in addition to rolling back the Affordable Care Act’s Medicaid expansion) is a benign sounding policy called “per-capita caps.” What that actually means is that instead of paying a fixed percentage of states’ Medicaid costs, the federal government would only pay a fixed amount per beneficiary. This cap doesn’t account for future economic downturns, unanticipated epidemics, or the expected increases in healthcare costs as the population ages. And it won’t keep track with annual increases in healthcare costs—if Trumpcare passes, Medicaid’s costs per beneficiary will quickly outstrip federal funding. That means that when the costs per beneficiary inevitably go up, states will need to either spend more of their own money or cut their Medicaid programs. Unfortunately, history suggests that most of them are likely to do the latter.
States will be faced with this dilemma sooner rather than later because the population is aging, and a larger percentage of Medicaid beneficiaries will soon be seniors. As we mentioned above, long-term care is not cheap, and seniors ― particularly those over 85 ― cost considerably more to cover than other groups such as children. States will be highly incentivized to kick seniors off the Medicaid rolls.
Alex Lawson is the Executive Director at Social Security Works; Linda Benesch is the Communications Director. Sign our petition demanding Congress reject Trumpcare and its reckless cuts to Medicaid―a direct attack on seniors and people with disabilities.