$750 billion out of Medicaid

Mitt Romney wants to throw your mother out of the nursing home, or bankrupt your family with the expense of keeping her there.

Here’s the math.

And here’s the human reality: Mitt Romney wants to throw your mother out of the nursing home, or bankrupt your family with the expense of keeping her there.

The most interesting (read: depressing) reaction I heard to the debate series was that “Romney came across as compassionate.” It it really impossible to make this a voting issue? Are the Democrats so afraid of the “welfare” label that they won’t go on the attack? Or do people really believe Slinky when he pretends the states can do it cheaper without doing it worse?

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

14 thoughts on “$750 billion out of Medicaid”

  1. “Mitt Romney wants to throw your mother out of the nursing home, or bankrupt your family with the expense of keeping her there.”

    How could you say that? Didn’t you see how compassionate he is? How much he cares? Why are you being so mean and unfair?

    I think that’s basically how it works. To actually accept the human reality you point out is a lot harder than disliking you for pointing it out.

  2. You can’t call the Republican platform incoherent. Their global warming denialism plank ensures that there will be plenty of ice floes to put the old folks on.

      1. And people who take responsibility for their own lives will simply be considerate enough to die when their money runs out.

  3. The only things that made Romney sound compassionate were the alternating sighs and whines of his voice, the audible manifestations of Condescension Through Cluelessness (which is my mid-week attemptat at charity).

  4. My understanding of what happens on nursing homes is, you have to use up all your money and once it’s all gone, then Medicaid will pay for a not very nice one. Smells of piss in the hallways, and not enough attention to bedsores. But Medicaid will pay, she doesn’t go to the street. And if you gave a lot of your money to your kids less than three years before, Medicaid will come after them and claw it back. Or you can pay (quite a lot of money) for long term care insurance.

    Lots of dreadful incentives here: your kids want you to give them your money early, then they are better off if they ditch you. You see everything you worked for all your life going to pay for a place you hate being, and your kids getting bupkis. Some of the incentives are decent, though: families will be financially better off if they can keep Mom at home, and that’s maybe a good thing for Mom, and certainly a good thing for the public purse.

    It gets worse going forward: when my #1 was in kindergarten, his teacher told me that of her 23 students, ten were onlies, ten were from families with 2 kids, my guy was one of only 3 from families of 3 or more. So the current system has a lot of old people depending on not a whole lot of middle aged payers.

    When Sebelius gave up on CLASS she said “For 19 months, experts inside and outside of government have examined how HHS might implement a financially sustainable, voluntary and self-financed long-term care insurance program under the law that meets the needs of those seeking protection for the near term and those planning for the future. The work has been groundbreaking in many ways and has taught us a great deal. … But despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time.”

    So, Mark, if Sebelius and her gang of quants couldn’t find a way, I’m not sure what the Evil Reeps could do. The current system at least encourages adult children at home as long as they can, with huge savings for the public. What is your alternative?

    1. Dave,
      You comment on this blog with some frequency. I invite you to demonstrate you’ve read a single one of Harold Pollack’s heartfelt blog posts about his brother-in-law. Unless I am completely confused, (1) Harold’s brother-in-law’s care is subsidized through Medicaid; and (2) Harold has not had to bankrupt himself to make this possible.

    2. To Dave:
      Many decent nursing homes will take patients on private pay and transition them to Medicaid when the private pay money runs out. However, I believe you are correct for nursing homes that intake Medicaid payments.

      To Warren:
      Harold’s brother-in-law is not on nursing home Medicaid, which is a separate program. (Also, he might be on social security disability, which is awfully hard to get onto, but–unlike Medicaid–a pretty generous program if you qualify.)

      1. I may well be dated here: it is a long time ago that I was an ambulance driver. When I was, I remember a run taking a woman who had been in a nice nursing home from which she was being expelled because her money had run out, and to a nasty one. That’s anecdata! I went to a lot of nasty nursing homes to take people to and from hospitalizations, and they were described as Medicaid Mills. But, yes, a long time ago, and I defer to people whose knowledge is more recent.

        1. My understanding is that the current system often is that an elderly person basically signs themselves over to a nursing home: the nursing home spends down their assets until they qualify for Medicaid, then they continue with their circumstances unchanged with their stay thereafter funded by Medicaid. At least, that’s what my grandparents were looking at in Massachusetts; state regulations may play a part. Mind you, the elderly probably couldn’t get into that nursing home in the first place without the buy-in that they do before their assets run out, and it probably becomes an actuarial calculation by the nursing home, regarding how long the nursing home will expect to care for the elderly resident before and after they’ve transitioned to Medicaid funding.

  5. Apples and oranges, Warren. If I remember correctly, Harold’s brother-in-law is disabled. I imagine he gets both SSI and Medicaid. Medicare will cover severely disabled children after a certain period has elapsed. The point is that for an elderly adult whose only handicap is being old, Medicaid will not cover long-term care while the person has any substantial financial assets, something that Harold’s brother-in-law probably lacks. I think. But it’s late and I have been working all day…

    1. Medicaid requires the “spenddown” of the assets of the individual covered, outside of primary residence. You have to spend your assets before the government steps in and pays for your care, or, you have to take personal responsibility for your care until such time as you can not. What Medicaid does not do is require assets from anyone else. Once the covered individual has spent their assets down below a certain line (its low, like $5 or $10k, again, excluding primary residence) Medicaid steps in.

      I am not sure what the objection to this is. Your assets cover your care and then Medicaid makes sure you never get kicked out of the nursing home for inability to pay and makes sure that the cost of your care never bankrupts your family.

      Dave is dead wrong that Medicaid only pays for crappy facilities.

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