Much of the 2012 policy debate, such as it is, has focused on Medicare, and with good reason -- the Romney-Ryan plan to replace the Medicare system with a voucher plan is important and worth scrutinizing in detail.
But in his convention speech last night, Bill Clinton not only stressed Medicare, he also delivered a forceful reminder about the importance of Medicaid and what would happen to the program under Republican rule.
"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 [Medicaid] 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, let's 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."
The future of Medicare is obviously important and should be a central issue in the presidential race, but as Matt Yglesias noted, "Medicaid is the one where much more is at stake on the ballot."
Why? Because the Romney-Ryan plan, with a position they're not at all bashful about, would block-grant Medicaid, leaving states with fewer resources, and leaving the poor and disabled in even more jeopardy.
Remember, unlike Medicare, Medicaid is a partnership between federal and state governments. The program undermines state budgets in a big way during economic downturns -- more people begin to rely on the program and states, which can't run deficits, struggle badly with the finances -- and the moment a Romney-Ryan administration gives states the flexibility to do so, Republicans governors will start improving their finances by taking health care from the most vulnerable, who don't exactly have lobbyists looking out for them.
What's more, as Clinton reminded us, for all of Romney's talk about leaving seniors' benefits intact, the moment the GOP guts Medicaid, plenty of elderly Americans will feel the effects.
There's no shortage of policy differences between the two major-party campaigns, but this is one of the more dramatic areas of disagreement, especially as it relates to the real-world impact of struggling Americans. Medicaid deserves to be an important part of the national debate, and kudos to Clinton for giving the issue the spotlight.
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But..but...multimillionaires NEED that extra $250K each year. Otherwise how will they fuel up their boats to go visit their money in the Caymans?
"nearly two-thirds of Medicaid is spent on nursing home care for Medicare seniors who are eligible for Medicaid."
And THAT, my friends, is a dirty little secret the Tea Party Generation does NOT want to talk about!
Here's the way it works: You have, say $500,000 in assets- stocks, your house, gold bars under the bed- and you are getting to that period where it is all down hill from here on out. Heart, Alzheimer's, whatever.
First comes Assisted Living. Then the Nursing Home. Finally, weeks- oh,God, maybe months or years!- in the Terry Schiavo Wing of Charon the Boatman's ferry slip.
All of which costs money. First the stocks, then the gold, finally the house. Gone. And you end up both broke and dead. Your heirs inherit your "Final Expenses."
But. BUT! You can pre-plan your End Times by carefully divesting yourself of all those worldly goods: You give them to the kids, spread over a government stipulated time period, and well before you sign up for the Golden Years Academy.
So, you are still on the way out, but now you are broke! No worries, mate- Medicaid will foot the bill.
Please note, that as of 2011 Medicaid Chronic Care requires 5 years of tax returns and five years of financial documentation,all accounts. Part of ACA is to grant state $$$ to track your finances and keep digital history. Transfers and gifting has gotten harder to accomplish.
If two-thirds of Medicaid is for nursing home care, and Romney-Ryan want to cut Medicaid by one-third, then in order not to affect healthcare for poor children, you'd have to cut Medicaid nursing home payments in half.
OK. Let's say we could do that by eliminating the sort of scam/fraud you are talking about--making every senior spend all of their assets on care before they qualify for Medicaid. Per the new rules in the ACA (which Mitt wants to repeal).
I'm sure this sort of crackdown on gift-giving is every bit as popular with the GOP as "death taxes." But if Mitt repeals, he will replace this part??
I don't see that in their plan; am I supposed to trust them on that as well?
I'm sorry, but I just don't see giving your money to your kids as necessarily a "scam-fraud." If you've got ten or twenty million stashed by the time you're on the downward slide, there's no way you're going to endure the kind of antiseptic (if you're lucky) warehouse Medicaid will pay for just so the Roman numerals can get more of your money.
Unless they've got diminished capacity and their kids are either greedy sociopaths or they were such terrible parents that the kids truly hate (both of which happen), the people who engage in "Medicaid planning" are people who will be on Medicaid eventually regardless because they just don't have enough to see them through to the end. By definition--again, unless their kids are sociopaths or just hate them--these are people whose kids are likewise in the "struggling to maintain the pretense of being in the middle class" which is rapidly becoming the norm.
Forcing people like this to transfer their entire modest store of wealth to the health care system and the Nursing Home Industrial Complex, rather than to the next generation, before the government will help is just one more tool the 1% are using to increase income inequality and get more and more of the nation's wealth flowing into their pockets.
Exactly right. Living Trusts and other divestiture schemes done at least 5 years ahead of time shifts the cost of "final" care to Medicaid.
Much more common, I'm sure, are cases like that of my wife's grandmother, who will probably be on Medicaid within the next year. She's 88 years old, has severe dementia, and while she can do basic tasks like dressing and washing herself, that's about the extent of her ability to take care of herself, which is why we are applying for assisted living or in-home care on her behalf.
Her assets? A house valued at ~$50K, subject to liens that reduce her equity to pretty close to zero. She lives on Social Security, plus a VA survivor's benefit.
I'm sure somebody's gaming the system, because if there's a system, somebody will find a way to game it.
But to game it, you'd have to have (a) enough assets of value to be worth protecting, but (b) not enough assets to enable you to afford better end-of-life care and living arrangements than what Medicaid will pay for. So you've got to be in a particular range of wealth.
And (c) you'd have to be foresighted enough to put those assets in a trust >5 years before you needed Medicaid. Most people aren't, because (d) most people don't get five years' warning that their need for Medicaid is coming on, and (e) even they can see it coming in the distance, it isn't worth the hassle to most people to do something about it. It's not like it'll make any difference to themselves; the only potential beneficiaries of such a scheme are their heirs.
It's worth putting protections in the system (like the five years of tax returns) to minimize people's ability to game a system. But you don't want to design the broad outlines of a policy around exceptions like these.
@low-tech There is truth to what you say but in all fairness the way in which nursing homes collect their money is criminal in my eyes. In the 1990's I worked as a medical billing specialist in a nursing home, the gravy is the private payer. They are the top of the food chain. Usually a person comes into a nursing home on Medicare or private insurance, they have a limited about of time to get better until the money runs out and they must start paying privately. A self pay patient in the 90's paid between $7000 to $10,000 a month depending on the care they receive, next on the food change is Medicare and private insurance both of which have a negotiated rate with the nursing home, paying about 40% less then the self pay patient, then when all resources have been depleted, including forcing the patient to sell their home and all their belongings, they are put on Medicaid. At this point the nursing was making about $3600 a month. In my opinion there should be no negotiated rates for healthcare, if everyone paid the same amount for each service then the cost of health care would be more affordable, or there should be a way for self pay patients to negotiate rates like insurance companies, medicare and medicaid do.
Kudos to Bill Clinton for the issues that he spoke to! I have to wonder how the "family values & morality" crowd sleep at night, knowing but not acknowledging that their actions will throw more than just Grandma to the "death panels" that they were so terrified of when the ACA was passed?!
I REALLY appreciated this part of his speech. too many middle-class Americans don't understand how Medicaid impacts this society
My son's friends had premature twins several months ago. Both babies required around the clock specialized care, special procedures and a lot of fancy equipment. One of them is still in the local children's hospital. The young couple, who both work, could never afford the cost of their babies care. Medicaid has picked up the cost. Tens or hundreds of thousands of dollars. I guess Romney's approach would be to sacrifice those babies on the alter of tax cuts for the "job creators."
Well, there's no actual altar.
I don't think.
But seriously, the Republicans spent so much time being concerned with those kids before they were born, you don't expect them to keep it up afterwords do you?
They are mostly concerned with getting out the Christian Right Evangelist vote. It's not really about saving babies from abortion. It's political strategy.
Why can't anyone call Mitt Romney what he actually is a CORPORATE RAIDER. People in the '70's and '80's knew what that was. Call a duck a duck.
He proves that art cannot compete with life, Gordon Gekko being a mere shadow of His Mormontological Majesty.
Nobody is talking about what a boon this block granting would be to lawyers, and how it would devastate the housing market! The only way alot of folks keep their homes is Medicade, otherwise bill collectors would forclose on them left and right. Why even buy a home when you can't protect it from vultures? Those people in nursing homes want to pass their homes on to their heirs, or sadly alot of them would choose death, literally. Lawyers would need new tricks to protect assets...
I never understood why we have Medicaid and Medicare. Why cannot they be one program? I have Medicaid and not eligible for Medicare due to the fact I did not make enough money in the four month period leading up to my disability. How is that fair? We need to learn to improve the medical insurance system that helps poor families, the disabled and our elderly. Even then Medicare only pays 80%. Medicaid pays 100%. There is a problem with the way the system is run. Republicans are not making a big deal about Medicaid because I believe they want to cut all funding to poor and disabled people. They want to get rid of the SSI Act signed into law by FDR. They want to get of the ADA (Americans with Disabilities Act) as well. Another good reason why anyone should not trust a Republican. They would in fact let the rest of us die since they believe only rich white people should have healthcare. They believe its a benefit of being rich. Healthcare is a basic human right and should be treated that way but when we live in the "I don't care about anyone but me" decade then that is hard to get people to care about the poor and disabled.
Your post corrects a portion of Pres. Clinton's speech, but, in doing so, I think you missed his point. After explaining that two thirds of Medicaid dollars go to Medicare-eligible seniors in nursing homes, the former President said this about the funding cut the Republicans have proposed: "It's going to end Medicare as we know it."
I don't think he meant to say simply that cutting Medicaid benefits (and block-granting the program) would "end Medicaid as we know it." His point, I think, is that Medicaid has become an essential element in the support given to recipients of Medicare, and that gutting Medicaid would therefore change what Medicare is able to deliver.
He was talking directly to seniors, and Medicare is what he meant to say.
I think he meant to say medicaid, but I take your excellent point.
I guess if we are going to be immature and nitpicking over every nuance said by former President Clinton then remember when he said that "He wants Obama to be the next president. How can he be the next president if he is already president? With my point made this is immature. Republicans will end Medicare and Medicaid as we know it. We all know that. Some of us are in denial about it.
Hey CONS, let's do some ARITHMETIC...
Name the Obama policies that added trillions to the debt and the amounts.
Then deduct that amount from the current $16 TRILLION.
The rest is GOP spending.
Spending to fix the GOP F'ups is still GOP spending and NOT Obama's fault so do not count those.
INTEREST ON the GOP created debt DOESN'T count either.
All progressives should start asking that question and doing that ARITHMETIC.
The CONS will NEVER have those numbers because they DO NOT exist.
I bet all you will get is NOTHING but insults and ridicule.
I love the Big Dog and I could have listened all night. So many things I could comment on in his speech, but I will go for the Medicaid remarks, since I have spent more than 20 years working in Medicaid. The Repubs want people to equate Medicaid with "welfare," a legal association that went away with Bill Clinton's welfare reform. "Medicaid" and "welfare" are not synonymous. Eligibility for "welfare" is just one of the many routes to eligibility for Medicaid, and a minor one at that.
Much public discussion of Medicaid focuses on parents and children, who do indeed make up two thirds of Medicaid enrollment. However, they don't really cost much overall. As President Clinton pointed out, nearly two thirds of Medicaid dollars go not to non-working, low-income families, but to elderly and disabled adults and some disabled children. I was a little disappointed that he singled out nursing homes, but of course that is what most people associate with long term care. The truth is that most long term care these days is delivered through home and community-based services, not to say that nursing homes and institutional care for developmentally disabled individuals isn't an important part of the picture.
Elderly or disabled adults who enter a nursing home and who are not rich soon run through their savings and have to rely on Medicaid, because Medicare long term care benefits are extremely limited. Many elderly and disabled adults avail themselves of home care in the community, which saves money while enhancing quality of life; however, insurance doesn't cover this kind of care, nor does Medicare. Medicaid is pretty much the only payer in the country to cover long term care in the home.
Even more than care for elderly adults, states struggle with providing care for disabled individuals, primarily adults and children who are developmentally disabled. Institutionalization was the traditional way of caring for these people in the past, but it has proven to be not only the least satisfactory option for the individual, but also the most expensive way of providing care. So, most states have expanded home and community-based services for these folks. And what program provides that vital but expensive care? Why, it's Medicaid, of course! And Medicaid brings anywhere from 50 to 75 percent federal funding to aid the states in meeting their obligations to these people.
Finally, Medicaid has become the default payer for the vast majority of mental health services in the country. Most insurance plans limit care, in spite of numerous state laws requiring parity of coverage for mental health. Huge numbers of children and adolescents who have mental health issues end up in "the system," going into foster care, and often requiring inpatient or residential psychiatric care. Who pays for that? Well, for the majority of young people, it's Medicaid. In some states, parents have to give up custody of their mentally ill children to the state in order for Medicaid to provide coverage. The alternative is bankruptcy for the parents or no care for the child.
I apologize for rambling on for so long. This is an issue near and dear to my heart, and I am driven nearly insane by the Republican portrayal of Medicaid as some service for the lazy and the undeserving (read: non-white minorities).
If people really understood the role Medicaid plays in our society they would.... well, hell, would they do anything different? Or would they let the conservatives continue to decimate lives across the spectrum?