Don’t cut Medicaid, say Ivy League doctors

The Medicaid cuts envisioned under the ACHA and the Trump budget would cause widespread harm, three health care experts wrote in the New York Times this week.

Health care experts at MIT and Harvard protested the government’s threatened cuts to Medicaid, pointing out in an op-ed in the New York Times this week that “roughly one in three people now turning 65 will require nursing home care” and that Medicaid will eventually cover “over three-quarters of long-stay nursing home residents.” Though that will be a minority of U.S. retirees, it still means millions of people, including members of the middle class.

David Grabowski of Harvard Medical School, Jonathan Gruber of MIT and Vincent Mor of Brown University wrote in protest of the American Health Care Act, which has passed the House and is now with the Senate. The AHCA would cut Medicaid by over $800 billion. The budget released by President Trump last month would cut another $600 billion over 10 years, they said.   

According to research by Grabowski, Gruber and Mor:

¶ Medicaid accounts for one-sixth of all health care spending in the United States. Nearly two-thirds of its budget pays for older and disabled adults, primarily through long-term care services in nursing homes. Medicaid pays nearly half of nursing home costs for those suffering from the effects of Alzheimer’s or stroke.

¶ In some states, overall spending on older and disabled adults amounts to as much as three-quarters of Medicaid spending. They will be harmed if the program shrinks by 25% (as under the A.H.C.A.) or almost 50% (as under the Trump budget). If those cuts are made, many nursing homes would turn away Medicaid recipients as well as those who might need Medicaid eventually. Many older and disabled Medicaid beneficiaries will have nowhere else to go, they said. 

¶ Lower Medicaid reimbursement rates would likely cause reductions in nursing home staffing, particularly of nurses. A 10% lower reimbursement rate leads to an almost 10% decline in the ability of nursing home residents to perform common functions of daily living. It raises their odds of persistent pain by 5%, and the odds of a bedsore by two percent.

¶ Lower-quality nursing home care would lead to more hospitalizations and higher costs for Medicare. Each year, one-quarter of nursing home residents are moved to hospitals, where the daily costs are more than four times as high. A 10% reduction in nursing home reimbursements causes a five percent rise in the chance that a resident will need to be hospitalized.

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