Medicaid dreams - Editorial

Nursing Homes, May, 2003 by Richard L. Peck

Poor Medicaid, nobody likes it. In fact (dare I say it?), there are people in high places who wouldn't mind killing the program outright. I'm not just talking about the Bush administration's plan to phase down the federal government's role in Medicaid over the next 10 years, though that would be a start. More revealing, perhaps, was the House Budget Committee resolution this March that proposed cutting $93 billion in projected Medicaid growth over that same time period. Yes, we know, "cuts in increases" aren't the same as "cuts," but what they mean, as a practical matter, is that tomorrow's Medicaid recipients won't have nearly the benefits enjoyed by their predecessors. At the rate we're going, Medicaid won't be much of a factor for them at all.

Oh, well. Medicaid never was very popular (except to those who gained access to otherwise unaffordable care). I remember writing an article in the mid-'70s about some Cape Cod, Massachusetts, physicians who were declining to treat Medicaid clients because it just didn't pay enough, or not on time when it did pay. Their turning away of these patients was billed as a patient care "scandal," but one had to admit that the physicians had a point (once you got past that pesky Hippocratic Oath), a point that still resonates with long-term care providers today. As a matter of business survival, Medicaid is a risky proposition. One could say that it's better than nothing--but now not even that is so sure, not with so many facilities threatening to succumb to red ink.

Does long-term care really need Medicaid? After all, maybe there really will come a time when people (or their companies) will purchase insurance against the needs of old age as routinely as they do against death and accidents, will willingly pay premiums to cover seemingly remote possibilities, and not quarrel with putting their houses on the line for "estate recovery" of uninsured costs covered by their states (in effect, paying back government for programs already b ought and paid for). Maybe they will have made such canny investments in the stock market and will have enjoyed such long-lasting good health that the concept of government assistance for long-term care will seem superfluous at best, and certainly not worth an investment of precious tax dollars.

The mass of Americans who wouldn't know a Medicaid estate planner if they tripped over one probably wouldn't want to bet on all this. Maybe Medicaid is a bad dream, but its alternatives are dreams, too. And when we wake up, what will reality be?

To comment on the editorial, please send e-mail to peck0503@nursinghomesmagazine.com.