My Neighbor Is On Medicaid Study
News flash! Our population is aging!
We’ve all known about this for years, but it is not easy for our country to adjust its systems to this new reality. This is not a partisan issue but one for which all Americans need to find new and creative solutions.
Healthcare systems and social service non-profits are supporting more and more people living in the community instead of nursing homes and group homes. Ride-sharing apps and golf carts are helping seniors stay mobile in rural communities across America. People with disabilities who grew up mainstreamed in our public schools don’t necessarily want to live in group homes anymore. And an army of Baby Boom volunteers is retiring from full-time work and looking for meaningful service in the community. But changes take time to imagine and implement.
The last Congress passed the ambitious Affordable Care Act, but high premiums threatened to make it unworkable for some people in 2017. The new Congress has worked to repeal and replace it with a new plan.
We do need to find new approaches to our future. We do need to slow the growth of the national debt we will leave to our children.
And – as Christians – we need to keep finding the best ways to love all our neighbors that are effective, compassionate, and sustainable.
In 1965, Congress enacted the creation of Medicare and Medicaid, declaring that older adults, people with disabilities, children and families living in poverty in America are entitled to a set of benefits to support them in living in the community.
In 2017, Congress has considered proposals to convert Medicaid payments to a “per capita cap” payment; that is, a predetermined dollar amount of average Medicaid spending per beneficiary. Under this approach, total federal spending would vary with the number of people in each state enrolled in Medicaid. Another proposal that has been discussed is a fixed “block grant,” changing the deal from a federal contribution that varies by number of beneficiaries to a fixed dollar amount that would be awarded to each state to use as it wishes to provide benefits.
These proposals have been estimated to take $350 billion to $1 trillion dollars out of Medicaid in 10 years, which is a reduction of up to one-third of today’s budget - even as the number of older adults needing support will be increasing.
Lutheran Services in America, the association representing 300+ social ministry organizations of the Lutheran Church in the United States, has opposed proposals to so deeply cut the Medicaid budget.
Our social ministry organizations, who together serve 1 in 50 Americans in some way each year, are working to innovate and remodel our services to serve our aging population while keeping as many supports as possible available for all of our neighbors who might need them.
We would favor a smart, thoughtful approach that announces a more gradual plan to bend the curve of spending on services, leaving our resilient healthcare and social service sectors time to apply their best ingenuity to adjust to coming changes and neighbors not suddenly losing vital services.
As driverless car prototypes zip around our cities, and Amazon begins to deliver everything from groceries to prescriptions, Americans can find their way to adapting - as they always have - to new realities in ways that work for the most people.
In the meantime, many Americans do not understand Medicaid and who is eligible for Medicaid services. For example, many Americans think of Medicaid as “welfare” even though 63% of Medicaid spending is for older adults and people with disabilities. As our population has aged, more and more seniors have “spent down” all their own assets, ending up with Medicaid support to help pay for nursing home care in the last years of their lives. People born with disabilities, such as autism, depend almost entirely on Medicaid support throughout their lives for healthcare and social services.
Hence, this short, simple primer.
We couldn’t possibly make anyone an expert in these complex federal programs in a few pages, but our hope is to:
- Remind Christians of God’s call to love older adults, people with disabilities, families living in poverty, and children.
- Lay out a very few basics from reliable sources of how Medicaid works and what “per capita caps” and “block-granting” means.
- Introduce Americans to some of their neighbors who are supported by the U.S. Medicaid program today.
We support the need for the continual rethinking of the way we offer and pay for services for our neighbors as the population ages. We urge our elected officials to take the time to find a more gradual approach to which our communities can adjust.
Jodi Harpstead, Former CEO
Lutheran Social Service of MN