Don't let legislators cut Medicaid

October 29, 2005|By R. Thomas Murphy

I write to advise your readers of the threat Congress is creating for our seniors. I speak of massive cuts and changes to the Medicaid program currently under consideration. Medicaid is a little understood federal program that provides health care and nursing home care for the impoverished. Both federal and state governments contribute to the total cost of running the program that is administered on a state-by-state basis.

For the past 40 years, Medicaid has played a crucial role in our country's health-care system by providing public health insurance for low-income Americans. The program protects those that are among the most medically and economically vulnerable - children, adults, disabled individuals and seniors - who do not have access to or cannot afford private health insurance. According to the Congressional Budget Office, in 2005 Medicaid will provide health coverage to 58.5 million people (including 5.4 million senior citizens and 9.2 million disabled individuals).


Older Americans benefit from an array of important services provided by Medicaid, such as: Hospitalization, physician services, long-term care, prescription drugs, clinic services, prosthetic devices, hearings aids and dental care.

While seniors represent only 9 percent of Medicaid's enrollees, they receive more than a quarter of Medicaid's expenditures. Seniors receive a larger share of Medicaid's expenditures because they require more frequent and expensive medical attention. The Kaiser Family Foundation estimates that in 2003 the Medicaid program spent almost $13,000 per senior.

Seniors also benefit from Medicaid because of its leading role in our nation's long-term care system. The program's spending accounts for 43 percent of our nation's total spending on long-term care. For example, Medicaid provides vital financing for nursing homes, which rely on the program for about half of their total funding. Further, nearly 60 percent of all nursing home residents receive Medicaid.

The fiscal year 2006 budget resolution passed by Congress targets the Medicaid program for billions of dollars in reconciled cuts over the next five years. Any cuts or funding caps to the Medicaid program would disproportionately hurt seniors by ending coverage for millions of beneficiaries and/or shifting rising health care costs to state governments already struggling to meet the needs of an aging population.

The Pennsylvania legislature recently enacted legislation to severely cut programs that help individuals stay in their homes and receive care as well as changing the rules for people seeking assistance in paying for their nursing home costs. Our state representatives did so at the same time they gave themselves large pay increases, and by all accounts, adjusted their compensation packages to include expensive, long-term nursing home care insurance.

The Pennsylvania Elder Law Bar and other groups that protect seniors lobbied vigorously against the cuts to the Medicaid program but the legislative leadership responded that they were needed to "cut costs." By the Commonwealth of Pennsylvania's own estimates, the pay increases will substantially exceed any possible savings that may be obtained by the Medicaid cuts.

Within the same budget process that cut Medicaid, our representatives passed Act 43, which now reinstates the concept that family, including children, may be held responsible for their parent's care. The Commonwealth of Pennsylvania may now seek a contribution from children towards a parent's nursing home care.

Currently, nursing home and in-home care costs are shared across the broad base of society. This is helpful and reassuring because any one of us may be stricken with a debilitating illness, stroke or accident. Medicaid provided hope to thousands that their hard earned dollars and homes were not effectively confiscated to pay for care.

Congress wants to change all that. They want to save money and in most cases that would be a smart thing. But Congress is also looking at taxes that the wealthy pay and cuts to the estate tax. The federal estate tax is only paid by individuals who die and whose estates are currently worth in excess of $1.5 million. Most folks don't fall into that class and will never pay the tax.

However, many of us may become ill and spend time in a nursing home. If those in Congress get their way, Bill Gates, Warren Buffet, and any number of other extremely wealthy individuals will be able to pass their entire estate on to their children without federal estate tax.

But the couple with a home and a couple hundred thousand dollars may lose everything in the form of nursing home costs. It doesn't have to be this way, but the only way to do so is to complain to your senator and congressman to insure that changes are not made that lead to a confiscation of your home and assets.

One way to do so is to contact the National Committee to Preserve Social Security and Medicare at or call 1-800-998-0180 in order to be connected automatically with your Senator and Representatives in order to oppose any cuts.

Editor's note: The author, of Waynesboro, Pa., is a certified elder law attorney, certified by the National Elder Law Foundation, as authorized by the Pennsylvania Supreme Court.

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