My Turn: Once again, Trump is looking to cut Medicaid

For the Monitor
Published: 2/12/2020 6:15:21 AM

Seldom has a campaign promise been broken as often as one President Trump made in campaigning for president, where, at least five times on Twitter, he promised not to cut Medicaid, even flatly saying that “Republicans who want to cut SS & Medicaid are wrong.”

Since taking office Trump has repeatedly tried to cut Medicaid, and not just the expansion that occurred under the Affordable Care Act. Rather, Trump has also gone after traditional Medicaid that serves over 62% of nursing home residents, and about which President Johnson, in signing Medicare and Medicaid into law, stated: “There are those fearing the terrible darkness of despairing poverty – despite their long years of labor and expectation – who will now look up to see the light of hope and realization.”

The Trump administration will run a deficit of over $1 trillion this year due to tax cuts, yet warns in its budget proposal that “Medicaid spending is increasing at an unsustainable rate.” Actually, according to federal data, overall Medicaid spending on nursing home care in 2019, for example, fell below even its 2016 level. That “rate” may indeed be “unsustainable” for those providing care, but it represents a savings for the federal government. Facts should matter.

Still, the Trump administration proposes to cut Medicaid by $920 billion. How would this savings be achieved? A national accounting study had projected that, in 2018, the state fell $72 million short of covering even those nursing home care costs it deemed allowable. Our Medicaid funding shortfall is already New England’s worst, taking beds offline, even as some policymakers in neighboring Massachusetts invite a further exodus of our caregivers by reportedly pushing to increase Medicaid caregiver wages there to at least $17 an hour.

Furthermore, how would such a huge cut in Medicaid assist us in our efforts to support a robust home-and-community-based care system (HCBS) for our elderly and those with disabilities? Nashua Sen. Cindy Rosenwald is leading a sensible bipartisan effort to lift arbitrary caps on Medicaid rates for such services. In New Hampshire the Medicaid rate for assisted living is only $52.54 a day, forcing closures of even town-run facilities. Home care agencies are struggling, just like facility-based care providers, to hire caregivers within scarce Medicaid means. Do we really want to be known as a state where you can make more in a vape shop than providing care?

The president’s budget proposal is not just a disaster for seniors in long-term care. It would eliminate the Senior Community Service Employment Program, which has provided income support to unemployed seniors under the Older Americans Act of 1965. It would cut $181 billion from the Supplemental Nutrition Assistance Program (SNAP) that so many who are poor rely upon: 4.8 million seniors nationwide according to one analysis of 2015 data, 16% of whom were 80-or-older.

Any objective analysis would determine that not only is the SNAP cut immeasurably cruel, it is also counterproductive. Consider the health consequences of creating food insecurity for the elderly – health consequences we would end up paying for through Medicaid or Medicare.

In the signing ceremony for Medicare and Medicaid, President Johnson also said that “[t]here are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help.” Regrettably, those are not the footsteps that New Hampshire’s elderly and those with disabilities can hear in President Trump’s budget proposal.

(Brendan Williams is the president/CEO of the New Hampshire Health Care Association.)

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