With its history of anti-tax Republicans, tax-fearful Democrats and bowing to corporate extortion to keep jobs in the state, Illinois has underfunded pensions, unpaid vendors and health care providers, and has many other economic woes. So, once again, Medicaid has become a target. Medicaid is often on the chopping block, probably because the perception is that it helps poor people. Now, the lingo is that the cuts being made are to save the program. No need to change priorities.
What exactly is Medicaid? It's a joint federal-state program, basically, the national health care safety net for the poor, children, the disabled and seniors, but administered separately by each state.
Who pays for Medicaid? Medicaid is a joint federal state program. The federal government has traditionally contributed over half of the needed funds to the various state Medicaid programs, but federal funds have been disappearing. There was a federal reprieve in the 2009 stimulus bill, but now those funds are gone. So, the states have to make it up. More federal cuts are planned.
What does the House Budget do to Medicaid? Right now, there is no cap on Medicaid spending. The program is based on need and eligibility. The House budget favored by Republicans including Illinois Tenth Congressional District Representative, Bob Dold, turns the program into a block grant that limits the amount of federal funds to a lump sum each year, subject to decreases as the political winds blow, and requires the states to make up the rest. The block grant proposal would cut Medicaid by one-third by 2022. To make up for the lost funds, the states would be given new flexibility to cut the number of people eligible, cap the number of eligible people who get the benefit, and cut the actual amounts paid out for the benefit of eligible and covered individuals.
What does Illinois Governor Quinn's Proposal Cut regarding Seniors and the Disabled in Nursing Homes or Supportive Living Facilities? The detailed list of proposed cuts can be found here. Because my focus is usually on the elderly and disabled in nursing homes or supportive living facilities, I'll detail some of those cuts here:
- Changing the Determination of Need (DON) for nursing and supportive living facility applicants. The DON is a two-part test that measures symptoms of mental functioning such as memory loss and the need for assistance with activities of daily living (ADL). ADL is a medical and legal term of art that includes bathing, dressing, grooming, toileting, dental care, transferring (getting around the house or from the house to the car or elsewhere), cooking, laundry, other housework, shopping, managing money and all the things we all do every day to take care of ourselves. The DON also includes a measurement of how well needs are met through other programs (noting that Illinois is way down on the list of states that provide programs to assist people at home). The proposal increases the DON from 29 to 37. Here is an study by the Illinois Department of Aging that describes how the DON is scored and what the scores mean. The change could operate to eliminate people with moderate dementia. or people without dementia, but a moderate to severe problem with motor skills.
- Repeal law requiring ambulance service between hospitals and nursing homes.
- Moratorium on new admissions to intermediate care nursing facilities--about 15,000 mentally ill people will find no place to live.
- Eliminate mental health programs for nursing home residents.
- Eliminating bed holds for nursing home patients temporarily transferred to the hospital.
What does all this mean to the average Illinoisan? If you're ok with Medicaid cuts because you're not poor or feel the poor get too many benefits at your expense, think about this: As was pointed out by one of the providers who does needs evaluations for the state here, the changes would make the average 65-year-old incontinent woman with cataracts and arthritis who needs help with cooking and taking medications ineligible for nursing home or supportive living assistance.
Do you have a member of your family who is elderly or disabled? Do you think you will always be able to take care of that person at home? Do you work? Would you have to keep your elderly and/or disabled loved one alone for long periods of time each day? Can you afford in-home daytime help without state assistance? What would the home look like if your elderly or disabled loved one was left to his or her own devices all day? Would medications be taken as directed? Would reasonably nutritious meals be made? Dishes washed? Would you be worried about the senior or disabled person setting the house on fire? Forgetting to lock doors or opening doors to strangers? How do you feel about changing adult diapers? Would your parent feel demeaned by having you, his or her child, changing the diapers? What if the only person able to be at home was one of the grandchildren? Ok if it's a 20 year old? How about a 16 years old?
Ever have to get the nursing home to send grandma to the hospital? I did several years ago when I was young and unaware of Medicaid rules. My grandmother became very ill one day when I happened to visit. She was so ill, I became alarmed, and we called an ambulance to take her to the hospital. There was no way I could have managed her in my car, so I felt lucky that there was available ambulance service. Turned out that she was in fact quite ill. She was in the hospital for several days, but what were we forced to worry about? That she'd lose her room at the nursing home. I had no idea that I might have risked her room, and it didn't really matter because she was too ill for me to ignore the issue for Medicaid rules. Turned out that I was lucky because there were limits to how few days the room could be empty before the home would have pushed her out. What will happen to people in similar situations when the limits are removed? Could my family have afforded the daily nursing home rate, about $60K each year then? Could yours? Remember it's probably more now.
What if you're the person who becomes disabled or grows elderly and infirm? Do you think you'll be able to keep your home, health or dignity without assistance? How will you feel about asking your children if you can move in and if the grand kids can give you the 4:00pm diaper change?
Do you think perhaps the country needs to change its priorities away from tax cuts for the wealthiest people and corporations, and unending war, so that seniors and the disabled can be adequately cared for?
you point out that you're not referring to "life saving measures" but rather "annual housing" type programs. well there you go: instead of looking for more tax money - make a choice: how should the dollars already being allocated be used. imagine how many seniors could be kept in quality housing in lieu of one $100,000 medical procedure for someone of similar age. Personally, I'm not suggesting an answer. What I am trying to do is frame the conversation away from: we need more money in the pot, to a new way of thinking: the pot is huge, bigger than every other country's, how do we want to use the money that's already in the pot.
to get back to your article, you seem to be down on 'block grants' as supported by Congressman Dold and House Republicans. but that's the only way the federal govt can establish a budget. they can't have an open-ended checkbook. first of all, the state organizations are about as corrupt as they come (Illinois is probably one of the worst, but they're all corrupt). but also, an open-ended budget does not force the hard decisions. And that is why this country spends more than everyone else for worse results -- American culture is afraid of making the tough calls. Our politicians are afraid because if they make the brave tough calls and telling people they can't have everything, they'll just get voted out.
It is not the responsiblity of the government to take care of me. That is my responsibility.
Janet - most of us understand your point: the standard should be self reliance and self sufficiency with a safety net for the few very unfortunate situations. However, this country is quickly becoming far too reliant on government handouts for far too much of life. We're nearly 4 years into a sluggish economy and unfortunately we have leadership in this country who have chosen to set a tone of telling people that the solution to their woes is to blame others and then take from others. What we need is someone to get in front of the nation like Reagan did after Carter and tell every man woman and child that they are the solution and that each of us getting up every day and working hard (even if that means looking for a job) is the solution. D64 - anyone one of us could describe a more desperate situation than the next. Many of us have those stories as personal experience rather than theory. The point is that there is already a significant portion of our country's resources directed towards healthcare - more than any other nation on the planet. The solution is not to throw more money at the situation but to use it more wisely.
5% of world's population and 25% of the prisoners We spend more on war than many social services We spend more Corporate money financing campaigns Healthcare costs are rising here as fast as anywhere in the world Ozzie and Harriet don't live here anymore and if they did, they would hope to have Medicare, Social Security and Medicaid to help them. after working all those years their life savings blew up in the dot com bust, real estate fiasco and those Bush Tax Cuts did nothing for them..... Nothing wrong with some emotion when it comes to caring about people, difficult for you but not wrong for someone else. Government is there for and by the people!
My point has been that people who are concerned that not enough money is being spent on whatever program or benefit they are emotionally attached to, have to find somewhere else within the existing healthcare budget to take from. Raising taxes or spending less on wars is not a solution to any healthcare woes because those two steps (and others) will be solutions to the debt crisis.
I know there will always be cases that one can find that are not usual. The orthodontist in this case received $2.7 million in Medicaid payments in one year. He evidently insists his patients keep their braces on until the patient's limitation is reached.
There's nothing emotional about seeing the need to protect Medicaid. No one without upward of $60K per year to spend will be able to afford a nursing home or other type of supportive living. A lot of kids won't go to college because mom and dad have to concentrate on saving for their old age or supporting grandma and grandpa. Seniors will live in dangerous and unhealthy situations, not to mention the lack of dignity. Children will be caring for their grandparents while their parents work. Some people think they're immune from this issues, but even if you're not planning on getting old or suffering an illness like Alzheimer's, you never know when you'll get into an auto or other type of accident, have a stroke etc. Your private health coverage will end when you lose your job and there you have it, you'll need Medicaid just like anyone else.
But you ignore the fact that the money needs to come from somewhere to pay for all these things. You ask why everything seems to require cuts -- have you seen the debt/deficit lately? Have you seen any news coverage of Greece, Italy, Spain, Portugal, or Ireland? You seem to want to tax more and cut certain things and then turn around and spend more on things YOU prefer. When is everyone going to realize We All have our own pet projects. But we all have to stop this craziness. Which is why i spent a bit of time laying out ratios in my previous posts that can be a starting point for budgets -- all of which counters your points that there has been cuts in federal healthcare spending in this country (there haven't been) or federal spending in Illinois (there hasn't been). But it feels like cuts because too many people have gotten stuck on the tit of goverment and just want more. We have a choice: make responsible decisions today or the marketplace will eventually knock on America's door the way the sheriff does when a bank forecloses on a house.
Here are the "effective individual income tax rates" as reported by the govt from two very different eras. As you will see - EVERYONE is paying a lower rate. You are against overseas wars, but not internal class warfare apparently. (and yes, the lower 40% are now getting paid to file a tax return!) JUST SAYING........ Quintile ________ 2007 ________1980 Top ________ 14.3 ________ 16.1 2nd ________ 6.1 ________ 10.4 Middle ________ 3.2 ________ 7.8 4th ________ -0.6 ________ 4.3 Bottom ________ -6.7 ________ 0.1
Do a little research and you will find that everyone got tax cuts.
Seriously....you need to get help with that OCD regarding the President. It's apparent no one in your family cares enough to get the ball rolling on that intervention I suggested a month ago. You have no doubt alienated your entire family. To bad. But...on the bright side...there are several whack-jobs here on the Patch that tend to agree with your nonsense...so you are not totally alone in this world. I feel kinda bad for you....NOT.....LOL.