The median annual household income in Nevada is $55,726. [Census] The total population estimate for 2011 is 2,723,322 and of these approximately 12.5% are over 65 years of age. Some simple arithmetic shows that about 340,415 Nevadans are over 65 years old. So what?
The question is important because some of these individuals will need home care services to deal with infirmities, some will need assisted living to remain independent, and others will require institutional care, aka nursing facilities.
As we can see from the Kaiser Family Foundation graph above, more Medicaid resources have been allocated for home and community based care since 1995. Long term care, which prior to 1995 meant institutional care for the most part, is now 43% home/community based health care services. The issue now becomes do we want to fund the Medicaid program at a level which will allow more low income Nevada residents over the age of 65 to remain at home, or do we cut program services such that we cope with only the most medically fragile?
The family issue, for that household earning the $55,726 annually, is how to provide care for an elderly relative who requires medical assistance beyond the financial capacity of the family to provide but who doesn’t need institutional care? There is no answer to this inquiry from the Romney/Ryan budget.
In fact, if as Senator Heller and some of his colleagues recommend, we repeal the Affordable Care Act (Obamacare) and do what the Republican ticket suggests — transform the Medicaid program into a block grant scheme — we cut approximately 38% from Medicaid services. [KFF pdf] If we drill down into state by state statistics, if Obamacare were repealed and the Ryan Budget was adopted our Medicaid program in Nevada stands to lose about 44% of its funding. [KFF pdf]
No one would (or should) be so callous as to suggest we slash funding for those with the most serious medical needs, especially those who need nursing facility care. However, if we’re looking down the line at a 44% reduction in Medicaid funding for state services then the obvious cuts would come “at the margins.”
Who’s marginal? Are low income single mothers with two dependent children under the age of 6 marginal? Are low income elderly persons who can still function — albeit barely — independently marginal?
The Medicaid program in Nevada* is an insurance program which pays servicers to perform some or all of the following tasks:
-Adult Day Care
-Assistance Shopping for Essentials
-Personal Emergency Response System (PERS)
* In order to qualify for the Nevada Home and Community Based Waiver as of 2012, the applicant’s monthly income must be less than $2,094. Their countable assets must be valued at less than $2,000.
Now, how many families can afford privately financed adult day care, companion care, housekeeping help, meal preparation, personal care, and shopping assistance? On $55,726 a year? On an income of approximately $2,000 per month?
The obvious conclusion is that perhaps the Republicans are advocating for Crowded Housing? If they bemoan the fact that recent college graduates are staying home with parents in a tight economy, think how much more familial the entire living situation becomes when the grandparents — or Uncle Festus or Aunt Minerva — move in? Especially when the elderly relatives are simply in need of the kinds of home or community based services likely to be declared marginal in cost cutting binges?
While this might all sound a little facetious, the fact is that most houses in the U.S. ( some 67%) have two or three bedrooms. [Census] Every parent’s dream for when the offspring depart, be it the new guest room, the man cave, the sewing room — whatever — fails when a no long total independent older relative needs a safe place to live.
A modicum of concern for middle income families who are struggling to maintain their standard of living might be in order. If we can assist middle income families with the costs associated with the care of a low income elderly relative; if we can chip in a bit so that a low income elderly person can remain independent as long as possible — then why is is necessary to cut 44% of the Medicaid program in Nevada so that millionaires and billionaires won’t have to revert to paying the income taxes they were paying back in the Clinton years — 39.6%. (They are current paying 35%. All this for 4.6%. )
Let’s guess that the hedge fund managers and Wall Street wizards won’t be decimated by a 4.6% tax increase, but a 44% reduction in Medicaid funding in Nevada will have a profound effect on the other 99.99%.