Medicaid Now Covers More Americans Than Medicare

Since LBJ signed into law health insurance for elderly people in July, 1965, Medicaid has grown from an oversite, thought to care only for the poor, to the providence of some 74 million Americans–1 in 5–covering their needs from the womb to the grave. Thus, Medicaid is now central to the nation’s healthcare system.

Moderate Republicans were unwilling to gamble with deep cuts in Medicaid and therefore helped doom the GOP’s drive to “Repeal & Replace” the Affordable Care Act (“ACA”) aka “Obamacare.” Representative Frank LoBiondo (R-NJ), a centrist, noted that almost 1 in 3 of all his constituents were covered by Medicaid. Likewise, Senate Republicans and Republican state governors expressed worry about jeopardizing care for the working poor, children and people with disabilities, and reducing funding for the care of elderly people in nursing homes.

Last week’s doomed GOP bill that would largely have undone the ACA would have ended the open-ended federal funding of the largest share of states’ Medicaid costs and replaced the same with block grants. Block grants were not precisely stipulated, thus the concern that some states would be treated differently or more unfairly than others (see Georgia’s Nathan Deal’s expressed concerns). Moreover, the unanswered question of what states would do if their block grant money ran out in say, month 9 of a 12-month period–simply tell recipients that their care wouldn’t be covered for the last 3 months? Block grants or a fixed-annual sum per recipient were the two options available and either would have clearly led to major cuts in coverage over time.

Nevertheless, many GOP governors and members of Congress intend to continue efforts to curtail Medicaid due to budgetary concerns. In 2015, the total cost of Medicaid nationally was more than $532 billion. The federal government funded about 2/3 (63%) of that and the states picked up the remainder. But, last week’s defeat of the GOP’s AHCA shows how difficult it is to take away an entitlement. This reality prompted Vermont’s Bernie Sanders to again promise to introduce a single-payer act in Congress. Indeed, California is actively considering a single-payer system for its healthcare needs.  States often have different names for the program, but whether you know it as Medi-Cal, MassHealth,or TennCare in Tennessee, it’s just Medicaid by another name. And the percentage of people who support cutting Medicaid spending has never exceeded 13%. Even Donald J. Trump recognized Medicaid’s political potency during his campaign, when he declared that Medicaid should be saved “without cuts” and repeatedly Tweeted support for Medicaid, stating as “wrong” Republicans who wanted to cut Social Security and Medicaid.

Medicaid pays for nursing home care and other long-term care for more than 6 million Americans older than 64 years. But the Republican bill, the AHCA, would have only allowed Medicaid payments to grow per recipient at an inflation rate less than the true inflation rate of health care costs. Thus, the AHCA would have eroded benefits over time. Beneficiaries would have had to re-enroll every six months instead of annually. This threat to the elderly led Florida  Representative Daniel Webster to vote “No” on the legislation. Central Florida constituents in one retirement center alone, The Villages, number greater than 150,000 residents. So, even as Medicaid has gained some hint of a stigma with all the political polarization from the Obama years, the reality that some people can’t afford health insurance whether or not they were “able-bodied” and working has caused even Republican-led states to expand Medicaid coverage. The expansion has helped with the opioid epidemic, birth defects, and the fact that 10,000 Baby-Boomers per day are still turning age 65. So, despite the stigma that, “people don’t deserve [free care],” no one wants to see someone they know lose their healthcare due to unaffordable costs. Perhaps equally as important, Republicans recognized that any bill that would lead to drastic cuts in Medicaid would simply hurt too many of their constituents.

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Nobody Wants Your Parents’ Stuff

For the first time in history, two generations are downsizing simultaneously: Boomers and their parents. And millennials don’t want “heavy” assets tying them down in case they need to relocate for a job opportunity. So, it’s best to start facing the inevitable and address the disappointments and sentimentality early on, so you can make appropriate arrangements ahead of the time you’re going to have to take action. Here’s a great article that provides some tips, insights, and solutions:  http://www.forbes.com/sites/nextavenue/2017/02/12/sorry-nobody-wants-your-parents-stuff/#1c10cd5f3afe

Medicare/Medicaid and the Rising Cost of Sexual Activity for Seniors

As Bill Mahr humorously, but perhaps, ineloquently stated as a “New Rule” last Friday night on his HBO show “Real Time,” the feds have been investigating the rising costs for durable medical equipment to see if certain types of equipment should be added to the competitive bidding list.  Enter the swelling controversy surrounding the penis pump, more formally known as the “vacuum erection system.”  Over the five-six year period between 2006-2011, Medicare paid an average of $451 per pump.  That left a $90 co-pay per patient with Medicare picking up the remaining 80%.  Comparatively, the VA paid only $186 for each device.  And, is anyone surprised that any average shopper could find less expensive pumps online?  Medicare purchased 473,000 pumps over the period investigated.  Predictably, there is controversy underlying adding these devices to the competitive bidding program, as many conservative groups argue that these expenditures are wasteful and detract from true “health” related expenditures.

But, perhaps we shouldn’t jump past the “health” aspects of sex so cavalierly.  Sure, in 2006 Congress barred medications like Viagra from being covered under Medicare Part D, the bill’s sponsor stating he didn’t want to have taxpayers subsidizing “grandpa’s recreational sex.”  But, there is a larger bias here that is arguably being overlooked:  the health aspects of sex in any adult human’s life.  The clear bias exists that seniors are, or should be, asexual.  Yet, how is that any different from the argument against younger, college age women who many on the left have argued should be insured for birth control pills.  It seems at some base level, Americans are just prudish at worst or giggling adolescents in general when it comes to a healthy discussion about human sexuality.  Is sex really just to procreate?  Recent studies say no and that more than half of men and 40% of women over age 65 are sexually active.

So, at least one author urges that we just insist that Medicare not get ripped off by price-gouging device suppliers and continue to cover the devices, perhaps as well Viagra and then the discussion will shift to condoms and safe sex and STD control for seniors as well as the general population.  This all in the name of health and to avoid “ageism.”  At some point, we all must address the limits the system can bear and the “Pentagon-Contractor” nature of the abuse and over-charging that is a huge source of the problems.  One thing is for sure, as millions of Baby-Boomers age into retirement, “No-Sex for Grandpa” rules probably are not going to work.

Aging Parents Can Forget to Pay Premiums Leading to Policy Lapses With Disastrous Consequences

If your older relative has a long-term care policy, photocopy the page listing the company, policy number and claims contact information. Keep the insurance company updated on new addresses, yours (if you are the third-party designee) and your relative’s. It wouldn’t hurt, if the policyholder is becoming forgetful, to check bank statements or call the company to make sure premiums are current.  One story reported by the NY Times shows the calamity that befell a Virginia family because paying the premiums slipped dad’s mind.  State legislatures seem hesitant to correct the problem by mandating insurance companies give more formal notice to policy holders or their third-party designees.

Children of Abusive Parents More Likely to Suffer Depression in Caring for Them as Elders

A Boston College study conducted from 2003-2005 shows that the impact of abuse never fades.  The study surveyed over 1,000 participants and ranked them into the following three categories:  1) those with no history of childhood abuse or neglect; 2) those who had been abused and were caring for their non-abusive parent; and 3) those who had been abused and were, to borrow the study’s memorable title, “caring for my abuser.”  Researchers also compared caregivers neglected as children with those who were not neglected.

Unsurprisingly, adults who were abused by their parents as children were more likely to show signs of depression, like lack of appetite, insomnia, trouble concentrating, sadness and lethargy, when caring for those elderly parents as adults.  But a stronger link arose for those category 3, caring for the abusive parent.  Those abused children caring for their abusive parent were still affected by that abuse and suffered from more depression than those in the other categories.

So, a person falling into one of these categories, especially category 3, has to really ask themselves whether they wish to subject themselves to this kind of risk to their own health as adults.  Worse, this finding raises the ugly specter of whether the abused child will succumb to the increased risk that they will abuse their charges, perpetuating a sorrowful cycle, if the care-giving becomes overwhelming.  Clearly, the natural feelings of revenge could easily surmount any obligatory honor or other societal barriers that otherwise keep in check these more primitive urges.

Whether it is those that are forced to care for their elderly parents who were abusive to them when they were children because there is no alternative or if there are other factors which place the adult children in such a precarious position, those who must engage or who choose to engage in the caregiver role must steel themselves for the impact on their own health.  They should be aware of the signs and symptoms of depression and methods of dealing with it such as therapy or support groups.  What is clear is that more resources need to be made available to care for the aging other than reliance on unpaid family caregivers.  For, as this article concludes, “Not only nice people get old.”

NY Times Article:  A Risk in Caring for Abusive Parents