House Majority Denies Low-Income Seniors and People With Disabilies Choice of Living in Their Homes

May 12, 2017

Some followers may have noticed a long silence. I’ve just rejoined the networked world after another fall — this one, unlike the first, a complication of a complication of a condition only recently diagnosed.

As you might imagine, I’ve been dwelling on health care even more than I would have otherwise. So I was ready to launch a diatribe against major, widely-reported harms inflicted by the House repeal-replacement bill.

I’ll instead focus on another that a columnist for TalkPoverty.org ferreted out. It’s directly relevant to people in my condition, i.e., elderly and/or disabled, at least temporarily, but only those with incomes low enough for eligibility in their state’s Medicaid program.

The Affordable Care Act did more than aim to expand Medicaid eligibility nationwide. It also offered state incentives to expand Medicaid in-home services to the overlapping groups I cited above.

Among the most successful, says the TalkPoverty columnist is the Community First Choice program. It increases states’ usual federal match on their spending by 6% for services that will maximize recipients’ ability to continue living safely and as self-sufficiently as possible in their own homes.

They can receive not only help with so-called activities of daily living, e.g., bathing, eating, and health-related tasks like taking medications on schedule, but also training so they can master these tasks. They can also get equipment to assist them and training on how to use it.

Agencies may further support living at home by providing hands-on help with tasks like meal preparation, light housework and transportation.

Here’s a true win-win. We all, I suppose want to stay in our homes, assuming they’re safe and in relatively good repair.

We surely prefer living in our community to an institution where there’s no one we know and good care is far from assured. Perhaps also not one we know who cares enough and lives close enough to visit regularly.

Government agencies surely prefer this too. An in-depth AARP study found that Medicaid paid roughly three times as much for institutional care as for home-based services. The data are far from current, but there’s no reason to think the basic cost saving has significantly changed.

Another study — this one of a pilot project — found that Medicaid costs dropped by about $11,900 a year for every older adult transitioned from a nursing home back into his/her community.

The House bill would eliminate the CFC program in 2020, cutting an estimated $12 billion in federal Medicaid funding in the first six years.

It’s a minuscule fraction of the nearly the nearly $840 billion the bill would cut from Medicaid. But it would somewhat more than pay for the late-added funds states could use for high-risk insurance pools, if they opted to let insurance companies deny coverage because of pre-existing conditions.

You may have already read about this provision because it’s how the Republican leadership quelled colleagues’ well-grounded anxieties about eliminating the ACA’s guarantee against such discrimination.

People who’ve suffered injuries like mine would be vulnerable, of course. But we’re told that insurance companies have classified a wide range of conditions as pre-existing, including acne, transexuality, pregnancy and recovery from domestic violence or rape with help from therapy.

For this and other reasons, the high-risk pools probably won’t offer insurance that’s either sufficiently broad or affordable. We need only look to pools states established.

They surely won’t without a lot more money than the Medicaid shift, even if states also tap other, more broadly defined funding streams. Two conservative economists estimated the annual cost at $15-$20 billion — this back in 2010. The left-leaning Center for American Progress estimates at least $31 billion.

I’m inclined to think that some House Republicans who voted for the bill knew this, though, as we know for sure, House Speaker Ryan chose to rush it through, rather than wait for an official score from the Congressional Budget Office.

We can also, I think, be pretty sure that House Republicans know they passed a bad bill, from both the promised repeal and replace-with-something=better perspectives. They believe passing nothing would be worse, what with their valuing their re-election prospects more than their constituents’ well-being.

Happily, the Senate will start from scratch and clearly intends to take as much time as the drafters (all Republicans) feel they need.

So the story’s far from over. But broad-based research and advocacy organizations—and the rest of us interested parties—need be less focused on this one hot issue, when there are already many others.

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