Thursday, May 26, 2011

Who Is Going To Bear the Costs of Caring For the Elderly?

Josh Marshall writes about the hidden side of the Medicaid program and the way Ryan's budget proposal would change it. As Josh notes, few people realize that Medicaid doesn't just cover the health care expenses of selected groups of low income people. It also pays for the majority of nursing home care in this country:
It's the part about turning Medicaid into flat-amount Block grants. Most people go right on by that part - "it's poor people, has nothing to do with me, so we'll cut dental and podiatry and vision coverage, etc. for poor people (as California Medi-Cal\Medicaid did a year or two back). That's too bad, terrible, but we'll save lots of money." But actually, as the link shows, Medicaid pays the bill for 66% of all nursing home residents. And these aren't the indigent - most\many of them are the result of middle-income people who have already run through their own money paying for their nursing home costs, and then become eligible for Medicaid. If Medicaid doesn't pick that up anymore, who's left? The children of the residents? Who are trying to send their kids to college and saving for their own retirement? Not that Paul Ryan cares, but essentially, states will need to choose between basic healthcare for low-income people and nursing home care for formerly-middle-income people with no money left. Who wins, you think?
All this may come as a surprise to many. It is not Medicare which covers long-term nursing home care for the elderly but Medicaid. If Medicaid funds for that are cut, who is going to pay?

Three additional aspects of this problem affect women directly:

First, women are the majority of nursing-home residents, due to their longer life expectancy.

Second, women are the majority of the employees in nursing homes and thus will face most of the job losses which might come about with reduced public funding of nursing home care.

Third, women are the largest group among informal (read:unpaid) care-givers. If nursing-home care becomes impossible to afford, who do you think will be expected to quit their jobs in order to become full-time unpaid caregivers? Mostly women.

And of course there are women (and men) who wish to assume the informal care-giving role. But the Ryan budget proposal isn't about supporting those individuals. After all, an informal care-giver without a paid job might no longer qualify for health insurance herself, and she would certainly have difficulty saving money for her own retirement.