Reasonable minds are free to disagree about the Affordable Care Act.
What has helped make the ACA’s attempted repeal in Congress so toxic, however, is that House and Senate legislation would also wreak havoc upon the “traditional Medicaid” that predated the ACA by 45 years. That fact played a large role in mobilizing concerns from many Republican governors, including Gov. Chris Sununu, and two Republican senators.
This is not strictly altruistic. Cuts under either the House-passed American Health Care Act, or the Senate’s secretive Better Care Reconciliation Act, would decimate the health care safety net and governors’ state budgets as well.
Vice President Mike Pence made the astonishing assertion, before the National Governors Association, that the BCRA “strengthens and secures Medicaid for the neediest in our society.” Actually, according to an analysis shared with the governors, the BCRA eventually would cut 36 percent of New Hampshire’s federal funding.
This would do far more than erase Medicaid expansion under the ACA. Testimony at three listening sessions held by U.S. Sen. Jeanne Shaheen across the state at nursing homes revealed the cuts likely would close every Medicaid-contracting nursing home in the state, for-profit and nonprofit alike.
New Hampshire already struggles to fund Medicaid long-term care under the current system in which every dollar contributed here is matched by a federal dollar. Its gap between nursing home costs and state Medicaid payments, for example, has been the nation’s third-worst. Its daily assisted living facility payments of $49 are below bargain-motel rates. The BCRA’s heartless rationing of care per Medicaid beneficiary would run up against the reality of our graying state already having the nation’s second-oldest population.
With low unemployment, our state is especially suffering from a shortage of caregivers, even before an age wave described as a “silver tsunami.” Most caregivers are women – nationally 85 percent of those working in nursing homes are women – and many are single moms pursuing living wage dreams.
These workers need Medicaid reimbursement that supports them, not Medicaid cuts that would eliminate both home- and community-based options and force facility closures. We need to prepare for the age wave. A modest down payment toward this future was made by the state budget. Congressional efforts would erase this progress. And where would those in need go?
I think of Mark M., a 52-year-old resident of a Portsmouth nursing home. He is paralyzed from the neck down, and moved into a nursing home to save money because the 24/7 care he needs would cost $500 a day in his home. He knows, because he is paying out-of-pocket. Federal Medicaid cuts would have closed his care facility – on average, 50 of his fellow residents are on Medicaid.
The average long-term resident of a New Hampshire nursing home is 83 and has dementia. He or (more likely) she needs 24/7 care. Care, meals and housing are quite efficiently provided by a nursing home at a Medicaid rate averaging $6.80 an hour, under the current system in which the state, in making its payments, ignores 28.94 percent of actual care costs.
New Hampshire residents with needs that can be served in residential settings face their own challenges. Consider the recent example of 22-year-old Alex Sanok, who has autism and waited 28 days in a hospital emergency room before a placement was found for him – in Massachusetts. Why would we want to make New Hampshire’s fragile care infrastructure even worse than this? We need to improve all of our options, not dismantle them.
Too often we are afraid to speak of public policy in moral terms. But BCRA drafts have been savage in their inhumanity, and a Senate tie vote broken by Pence has cleared the BCRA’s runway. We must be a better society than this.
(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)