Listen now, this is important!

Hey there retiree, are you feeling safe because even if Romney wins they're promising no changes to Medicare for those currently over 55? As Bill Clinton said often in his speech to the Democratic National Convention "Listen now, this is important!"

Clinton opined that the Republican candidates were decent men who intended to keep their commitments. It was important, he said, to know the specifics of those commitments. Let's spend a moment talking about one of those commitments: turning Medicaid into a block grant program and shrinking it by 1/3 over the next 10 years.

Many Americans think of Medicaid as free health care for the poor. We see stories on the local TV news about someone who calls for an ambulance for a ride to the hospital whenever he needs to fill a prescription and our minds fill with stereotypes of the undeserving/ungrateful/too lazy to work welfare queens portrayed by Ronald Reagan.

"Too bad for them," we think. They should be grateful for anything they get. In reality, medical care for the poor amounts to about less than half of Medicaid spending. The majority pays for nursing home care for the elderly and help for individuals and families with disabilities, Many of the elderly and disabled are solidly middle class, but the cost of nursing home care or needed services for children with problems such as Down's syndrome or autism are beyond the means of most middle class families.

Today's NY Times carries an article titled With Medicaid, long-term care of elderly looms as a rising cost. It begins: "Medicaid has long conjured up images of inner-city clinics jammed with poor families. Its far less-visible role is as the only safety net for millions of middle-class people whose needs for long-term care, at home or in a nursing home, outlast their resources."

"With baby boomers and their parents living longer than ever, few families can count on their own money to go the distance. So while Medicare has drawn more attention in the election campaign, seniors and their families may have even more at stake in the future of Medicaid changes — those proposed, and others already under way."

"Seniors...will face uncharted territory if Republicans carry out their plan to replace Medicaid with block grants that cut spending by a third over a decade."

"The move would let states change minimum eligibility, standards of care, and federal rules that now protect adult children from being billed for their parents’ Medicaid care." [The blog post that has received the most views is the one titled I'll bet you didn't know this about nursing home care. It details how, in some states, adult children can be billed for nursing home care of their parents, even if they had no say in choosing that care.]

The article points out that a vast majority of the nation's 1.8 million nursing home residents rely on Medicaid to pay for their care.

"Many people assume that Medicare will cover long-term care, but at most it covers 100 days of rehabilitation, not so-called custodial care — the help with activities of daily life, like eating and bathing, that the aged can need for years." Nursing home care can easily cost $70,000 to $80,000 per year.

"To be eligible for Medicaid, however, a person typically can have no more than $14,800 in assets, and though some lawyers specialize in setting up trusts that shelter certain assets, the federal government has periodically closed loopholes that allowed it." 

Medicaid planning is always the most popular workshop topic at our annual retired teachers' conference. People are desperate to find out how they can avoid the tragedy of needing to "spend down" to the poverty level if one spouse needs nursing home care provided by Medicaid.

"No state has a more ambitious plan to overhaul Medicaid than New York, which has the biggest Medicaid budget in the country — $54 billion — and spends about 41 percent of it for long-term care, almost half on nursing homes."

"Under the block grant vision of Medicaid, that federal role in oversight would end. Richard J. Herrick, president of the New York State Health Facilities Association, a trade group, says that since Medicaid rates have been cut well below cost, he would welcome a change in rules that would let nursing homes bill families for their elders’ care, in addition to what Medicaid pays."

Listen now, this is important! It's hard to imagine that any of us who are over 55--or our families-- will be better off in a situation such as this.