Political Animal


August 16, 2012 9:44 AM Old Folks and Medicaid

By Ed Kilgore

In backloading reductions in federal spending on Medicare to gradual erosion of “premium support” over time, while “grandfathering” benefits for Americans 55 or older, the Ryan Budget treats this program much more gently than Medicaid, which is “block-granted” and flat-funded immediately, aside from Ryan’s proposed cancellation of the Medicaid expansion provided for in the Affordable Care Act of 2010.

So old folks do better than young folks under Ryan’s tender care, right?

Well, not exactly. As Joan McCarter usefully reminds us at Daily Kos today, Medicaid is the ultimate safety net for lower-income seniors, paying for Medicare premiums for some and for long-term care for virtually all of modest means. More than two-thirds of America’s nursing home residents—two-thirds—are having their basic needs met by Medicaid. So with federal Medicaid funding being cut an estimated one-third over the next decade if Ryan gets his way (not cuts likely to be offset by the typically Republican leadership in the states most affected, who are already whining they can’t afford their current costs), and Romney apparently even more inclined to aggressively follow the block, cap and dump approach, it’s going to get tough fast for lower-income seniors.

This includes a lot of people who have fallen out of the middle-class and lost most of their assets as they grew older and sicker. So in general, if Romney/Ryan win this election, and get a Republican-controlled Congress eager to enact some version of the Romney/Ryan budget plans, then we may soon see revolutionary changes in how people reach the end of their lives in this country. It won’t be pretty.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • stormskies on August 16, 2012 10:04 AM:

    There in only one thing to say about these pigs called Ryan/Romney: THEY ARE FUCKING SADISTIC.

  • boatboy_srq on August 16, 2012 10:08 AM:

    There's another aspect of this. Eldercare is expensive - horrifically expensive. In-home assistance can exceed $50,000 a year for simple part time unskilled support, assisted living costs are nearing twice that, and full-time nursing care is often well into six figures (though only the last is covered by Medicare/Medicaid). Medicaid, conversely, is only available to those without nearly any means: even ownership of a primary residence is often deemed sufficient "wealth" to deny acceptance to the program. As a result, anyone outside perhaps the top 10% has looked at, if not implemented, a strategy to handle their assets in such a way as to dispose of assets in order to qualify for the program.

    "Falling out of the middle class" as mentioned here is becoming standard practice for anyone who could defensibly benefit from Medicaid and whose assets disqualify that person from the program, yet whose same assets are insufficient for providing for his/her care for any extended period.

    Financial advisors to the retired or imminently retiring have encouraged this pattern as the least traumatic for the elderly. There are multiple legal instruments that are also used to make these transitions, if not painless (far from it), at least more manageable for the elderly and their caregivers.

    Medicaid "planning" as envisioned by the GOTea would throw all but the top 10% (if the proportion unaffected is even that big) right under the block grant bus.

    Obviously changes to Medicaid will impact lower-income seniors. What nobody seems to understand is that, as eldercare costs have spiralled, almost all seniors in the US become lower-income very very quickly - and the changes will have far broader impact than anyone making policy can possibly imagine.

  • rea on August 16, 2012 10:08 AM:

    includes a lot of people who have fallen out of the middle-class and lost most of their assets as they grew older and sicker

    In act, there is a whole small industry based around showing people the proper way to divest themselves of assets so that medicaid will pay for their nursing home.

  • T2 on August 16, 2012 10:19 AM:

    all of the older folks I've talked to seem to agree with me - IF the Conservatives take over this year, their "we won't cancel anyone over 55" will turn quickly into "we have been handed a crisis by Obama and the Dems that now require us to cut back benefits now, and extend retirement age to 70 now" and on an on.
    Their goal is to eliminate Medicare and Social Security and everyone knows it. And the fools who vote for them will be shocked when they find out the cuts apply to them as well as well as it does the minorities they hate.

  • c u n d gulag on August 16, 2012 10:19 AM:

    Yes, son, my father talked about his father and the great "Geezer Medicare Mob Riots" back in the fall of 2013.

    You see, my grandfather, like millions of other seniors got screwed by President Romney, his Vice President, and the other Republicans in Washington, and realized that they had nothing left to lose anymore.

    So they marched on DC, and, though a few of them got killed, and many more hurt, too many soldiers and police didn't want to shoot the old folks, since their parents and grandparents might be among them.

    And so, the "Geezer Mob" got ahold of R&R, and the rest of the R's, and we don't talk about what happened to all of them, except to say that it took a long time before the clean-up crews got done in DC.

    And the old folks got their Medicare and Medicaid back, and a raise in their Social Security, paid for by tax increases on the rich people who didn't want to have clean-up crews working months to get their stains out of the mansions.

    And now, not only are the seniors happy, but so are the rest of us, whose futures are assured.

    Hey, I have an idea - let's you and I take a trip on the new high-speed train running MA to SC and surprise your Uncle and his husband on their 25th anniversary, and meet your new nephew? And on the way back, we can catch your Aunt and her new wife in TN? Sound like a plan?

    And WE ALL lived happily ever after - until we got old, and then Medicare and Medicaid and the rest of us, helped our families take care of our needs.

    Sweet dreams...

  • Percysowner on August 16, 2012 10:21 AM:

    My mother-in-law spent her last years in a nursing home, funded by Medicaid. Medicaid allowed my father-in-law to live in his home until his death. He didn't have to bankrupt himself to keep her alive. My husband and his sisters and brothers were able to own their homes and not have to take their parents in. My mother-in-law needed 24 hour care, something no one in the family would have been able to provide. This will hurt real people in horrific way.

  • RepublicanPointOfView on August 16, 2012 10:38 AM:

    "It won't be pretty."

    A matter of opinion. From our republican perspective, it will be just fine. All we want for old people who have not accumulated enough 'personal responsibility' and wealth to fund their own care is "Die - quickly".

  • Mark-NC on August 16, 2012 11:07 AM:

    For: RepublicanPointOfView on August 16, 2012 10:38 AM: above

    You've nailed it perfectly! (as in Alan Grayson of course)

  • JM on August 16, 2012 11:19 AM:

    The D's cannot emphasis this enough. Hardly anyone has long term care insurance and everyone is subject to ravages of old age. I remember when my Mom got Alzheimers. My Dad gave her care at home for many years but the day came when she had to have professional care. Poor guy thought he would go bankrupt, the last idea he needed while under that kind o stress. Fortunately, I did a little research (no internet in those days, got a lawyer) and figured it all out. Wouldn't you know it, after 2 years of making payments she qualified for medicaid. No change in care, no hassle, no additional stress that surely would have killed my father. Dad was able to live out his remaining years in dignity. I will add, my father was far from poor. The nursing home cost about 1,000 a day (with accoutrements). For qualification under Fla. Medicaid law they didn't count your pension income, private or SSA or annuity income against you. Also, you could own your home, a car and have 50G in the bank. That was enough for him to live fine. My Mom lasted 5 more years and dad surely would have gone bankrupt.
    Have we become this heartless?
    Also, what about the disabled? They will surely be impacted and boy, you can not imagine the stress their care givers are under to begin with. Right to a shitty life is what the Ryan's of the world demand.

  • Mimikatz on August 16, 2012 11:32 AM:

    Hey c'mon. Paul Ryan's mother took in HER mother when she had Alzheimer's and if it was good enough for Paul Ryan's mother, it is good enough for you.

    The other large monetary component of Medicaid is aid fir disabled people, includig children and adults. There are a lot of middle class people who would lose aid there too.

    The real, underlying issue is that medical care costs have gone up so much that we need to be sure we are paying only for what is effective and needed, and we need to, ahem, socialize the risks because we can't know in advance who is going to need expensive care and who isn't.

  • Ron Byers on August 16, 2012 11:39 AM:

    For all you people who say they all do it and politics is the provence of the old timers there is a reason all you young people should make sure you and all of your friends vote Democratic. If the Republicans win you can count on taking time out of your career to care for mom and dad as they grow old.

  • boatboy_srq on August 16, 2012 11:39 AM:


    Have you looked into long term care insurance in much detail? Policies purchased in any given year are unlikely to provide meaningful benefit as little as ten years later. The fine print is mind-boggling: the disallowances, exceptions, limitations and other "non-covered" items are nearly innumerable. And by the time any responsible person who purchased said coverage actually needs it, the benefit is so minuscule as to be near-worthless - and likely only honored at some of the worst and/or most expensive facilities. Long term care coverage in the US is a bad joke perpetrated on the populace by scam artist insurers looking to pad their bottom line while maintaining a good "responsible corporate citizen" facade.

    My mother (also in FL) had such coverage. We cancelled it when it became clear that the only way it could be redeemed was to move her into an ALF approximately 100 miles from her home and her physicians (the nearest one that took the policy) - and even then the coverage was 20% of her total obligation. Don't misunderstand me: any reduction in expense is valuable. But the intangible costs (a whole new medical team with no history, a long move, and complete and total separation from all familiar surroundings) were far too great, and the benefit too small to be meaningful - especially when local alternatives were affordable enough to make up the difference. FYI also the insurer was also being sued (multiple class-actions) by customers who were denied coverage even though they jumped through all the insurer's hoops.

    So, yes, we have become this heartless. Chalk it up to the Me Generation getting their hands on the reins.

  • schtick on August 16, 2012 11:40 AM:

    The mail just came and I got my flyer from americanactionnetwork.org telling me the dems are raising premiums on Medicare Part D. They have a little quiz for me to take asking me if I support Obamacare. They have a selection for my concerns about Obamacare as in; govt controlled healthcare; higher costs; cuts in benefits; govt interference between you and your dr (that's a good one!); and last but not least, limited access to treatments. (If I didn't know better, I would think they were talking about the teapub birth control and anti abortion laws).
    Next is if I oppose the President's 500 billion cut to Medicare. Do I think Medicare should be preserved as it is. And the final one, am I concerned about protecting my Medicare Prescription Drug Coverage.
    Urge your Congressman Richard Hanna to oppose H.R. 2190.
    I have half a notion to send it back with some comments of my own and telling them to send a message to my local teapub rep here that I'm sorry he chose to drink the koolaid.

  • Varecia on August 16, 2012 11:43 AM:

    "...So in general, if Romney/Ryan win this election, and get a Republican-controlled Congress eager to enact some version of the Romney/Ryan budget plans, then we may soon see revolutionary changes in how people reach the end of their lives in this country. It won’t be pretty..."

    It's already not too pretty for a lot of the elderly, so one can only imagine in horror how bad it will get. It's an issue that gets little to no attention from anyone, but after having dealt with the end of life situation of both my in-laws and my mother, I came to really understand first hand what a neglected issue this really is.

  • Tired Liberal on August 16, 2012 12:04 PM:

    Time to remind the self-righteous oldsters who think they have earned everything they get from Social Security and Medicare (but are quite willing to pull the run out from under those under age 55) that they have a dog in this fight too. They tend to look at Medicaid as something that undeserving and shiftless younger people collect. In fact, substantial Medicaid funds go to pay for their fellow seniors in nursing homes.

    As anyone who has had a family member in a nursing home just how quickly you run through the life savings. Working class people who make $12-15/hour (if they are lucky) are not likely to be able to save enough for their old age, and it is unrealistic to assume they can pay premiums on long-term care insurance starting by age 50 when they scarcely pay the bills and the premiums on their health insurance.

  • End of the Line on August 16, 2012 4:26 PM:

    My daughter is an only child so will have two parents to care for. It appears that she will never have children, so pray tell (oh wise republicans) who will take care of her? Or is that part of the "get wealthy" program where you also have to have a slew of children so someone is always available to take care of you when you grow old?

    How sad. How immensely sad.

  • v98max on August 16, 2012 10:30 PM:

    Republican family values amount to four generations living under the same roof, out of economic necessity. When you live with your parents until you're 30 because there's no jobs, and live with your parents when they're 70 to tend their health needs, the window of opportunity is pretty narrow, unless you're rich already.