An Unadvertised Bomb Inside Repealing The ACA

Medicare or Medicaid – when Republicans change it we will lose

Look out Kids, Mom and Dad may break you

Filial responsibility. Ever hear of it? This is an old concept in law that goes back to the English poor laws in the 1600s. Stated simply, it means that children are liable for the bills their parents run up if the parents don’t pay.

As people live longer and longer (although the US is the only country where life expectancy is going down) the chances of ending up in a costly care situation at the end of life is becoming more and more likely. Nursing home care costs in the neighborhood of $80,000 per year or more. Not many of us have that money just laying around.

The cost of nursing home care in this country is most often covered by some private insurance in people have purchased it, and some combination of Medicare and Medicaid.

Republicans want to change Medicare to a voucher system where the elderly will get a yearly voucher to pay for private insurance. Good luck finding any for profit insurance company that will cover older folks with lots of pre-existing conditions for any price. That is why Medicare was created.

When Medicare was created in 1965, less than 50% of seniors had health care and more than 30% were in poverty. Medicare helped alleviate both of these situations. By throwing the elderly back to the whims of the for profit insurance companies for healthcare we will see a return to numbers like this in no time.

Another major component of Republican health care that will have a huge unadvertised effect will be changing Medicaid to a block grant system. The proposal that is getting a lot of play is that states (because states can get the money to where it is needed) will get a bloc grant based on some formula. Once the amount per state is set, it will be an absolute number that can’t be increased. In short, if Iowa got $10 billion in 2020, it would still be $10 billion in 2050 no matter what inflation did.

While most of us think of Medicaid as a program that provides health care for the impoverished, most of us don’t realized that a large chunk of medicaid dollars end up going to pay for seniors in nursing homes who have exhausted all other forms of payment. Thus medicaid is the main tool that allows those in their final years to live with some dignity and not die in poverty.

So what happens when Republicans repeal the ACA (aka Obamacare) and replace it with their antiquated ideas of a health care system in service to profit? With the Republican concept block grants to the states we will see a lesser amount coming to the states. In states like Iowa where Branstad unilaterally profitized the system for his cronies to make big bucks on we will most likely see a larger portion of medicaid dollars being siphoned off the top for the profit of the administrative companies. Thus those who depend on medicaid will see less and less get to their level to pay for their care.

Yet someone has to take care of the elderly and the cost of their care won’t diminish as medicaid dollars shrink. Someone will have to pay the bills. In Iowa and some 30 other states their are laws on filial responsibility. That means that the somebody who will be paying those bills will be the kids. Or at least they will be expected to pay the bills. Whether they can or not may result in some lawsuits.  From Cornerstone Financial group:

“In the future, will assisted living facilities and nursing homes cleverly exploit such laws (and legal precedents) to file claims or lawsuits against the children of patients? Baby boomers, Gen Xers, and millennials may face that risk.”

What do you do if you can’t pay for the needed care? Trying to care for them yourselves is always a possibility, but few of us have the facilities, skill or time to do such a demanding job. Caring for a dependent individual is an extremely demanding and exhausting job. We are talking about taking care of parents in their 80s and 90s and possibly invalid. This means the children themselves will be possibly in their 60s maybe 70s with their own health problems.

No doubt many who voted for Republicans thought that anything like what’s described above would happen. After all, it is not happening now, right? Well, that was due to planning and acting with the good of all in mind. While the system we have now is far from perfect, at least folks are no longer going bankrupt from medical bills.

Republicans aim to change that and quickly. Cut Medicare, cut medicaid, push laws that make the kids responsible for their parents bills and surprise! Once more Republicans have created a way to shift money from the poor and middle class to the wealthy thanks to laws that screw the average American. And Americans voted for it!

Incorporating elder care into a fully functional single payer not for profit health care system would be much cheaper and would eliminate the fear of poverty caused by health care bills. It is what every other advanced country in this world does, except us.

Jacki Schechner, former newscaster on Al Gore’s cable station and one of the designers of the Affordable Care Act does a great analysis of Republican proposals. It is a short article, well worth the read. She concludes the article with this common sense suggestion:

No, what we have now isn’t perfect. I’ve never defended it as such. But the ACA is an improvement on what was happening before, and I believe if we keep going, we can do even better. If we put partisan politics aside and let really smart people who understand how our health care system works get together to design a way to improve it away from the influence of corporate lobbyists and special interests, we might be able to achieve something great.

Until that happens, the best we can do is help people understand what politicians are talking about when they threaten to “repeal and replace” the ACA. It’s a lot more complicated than the catchphrase suggests. Take a moment to listen to what the people who have been fighting for reform for years – in some cases, decades – have to say. I promise they know your pain. They’re on your side. They want to make it better too. And they know that you can’t pick and choose the good stuff, get rid of the less popular parts of the law, and somehow it all magically just works out.

 How about this idea? Let’s repeal and replace the stale rhetoric surrounding the ACA and start talking about what it would take both to expand access and drive down cost. You know, what we set out to do with national health care reform in the first place.

About Dave Bradley

retired in West Liberty
This entry was posted in Affordable Care Act, Branstad, Health Care & Medicare, medicaid expansion, Medicare, Obamacare, Public Health, Republican hypocrisy, Republicn Policy and tagged , . Bookmark the permalink.