Popular support opposes funding cuts

At a glance…

A groundswell of public opposition to any cuts affecting the nation’s elderly have many in Congress scrambling to find less controversial ground.

The politicians in Washington are running scared, worried about voter backlash over massive budget deficits caused by the recession and the actions taken by the Obama administration to cope with it, combined with the expense of fighting two wars, passage of healthcare reform, and on and on.

Many Democrats see the Republicans seeking political advantage as they stir up anti-spending sentiment among the electorate, pandering to the upstart Tea Party people, even to the point of leaving town for the July 4th holiday without approving legislation extending unemployment benefits for millions of Americans who are out of work.

But it could be that the politicians have misread the tea leaves when it comes to spending to support Medicaid funding in support of care for residents in nursing homes and other long-term care facilities.

The American Jobs and Closing Tax Loopholes Act, H.R. 4213, was stalled in Congress. It would extend increased federal Medicaid funding for the states from December 31, 2010, to June 30, 2011. The legislation is crucial to many states that have been counting on it to avoid reducing their Medicaid programs, which, of course, are critically important to the nursing home industry.

Organizations representing the industry were putting the heat on Congress to pass the bill, with members being urged to contact their lawmakers, warning that without an extension of the increased federal Medicaid match, severe reductions will be imposed-to the detriment of the nation’s elderly.

The Alliance for Quality Nursing Home Care (the Alliance) released a study that said minority skilled nursing home residents could be disproportionately affected by Medicaid payment shortfalls. And the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) launched a bus tour of 40 states to bring attention to the issue, warning that without an extension of the increased federal Medicaid match, severe reductions will be imposed.

“Congressional passage of emergency Medicaid relief is urgent to protecting seniors’ access to quality care, preserving the jobs of the frontline care staff who help improve seniors’ quality of life, and defending the fundamental right of every American to live dignified, productive, and healthy lives in old age,” said AHCA/NCAL President Bruce Yarwood.

Popular support

But perhaps more significant than the publicity the bus tour was intended to bring are conclusions of a nationwide survey by The Mellman Group commissioned by AHCA/NCAL, which show that money to support nursing homes and assisted living facilities is backed by a huge majority of Americans, despite the impact on the federal deficit. If that’s the case, the politicians might well be advised to look beyond the rhetoric from the Tea Party supporters and others who rail against government spending without thought to the impact of such actions.

According to the survey, 62% of voters favored additional federal funding for Medicaid, and by a 73 to 18% margin, opposed cuts in federal reimbursements to skilled nursing facilities (SNFs), including 61% who are strongly opposed. The survey showed that every demographic group is strongly opposed, including Republicans, who opposed cuts by a 77 to 17% margin, while conservatives oppose them by a 75 to 16% margin.

Moreover, voters said they would vote against members of Congress who approve such cuts. Sixty percent of those likely to vote in the 2010 midterm elections said they are more likely to vote against a member of Congress who votes to cut Medicare reimbursements for SNFs, to only 12% who said they were more likely to vote for such a lawmaker. According to Mellman’s data, that sentiment extends across party lines as strong majorities of Democrats (59 to 11%), independents (53 to 11%), and Republicans (67 to 11%), said they are more likely to vote against their member of Congress who supports the cuts.

Clearly, there is grassroots support for nursing homes and the residents cared for in them, and that message needs to be brought home.

Similar opposition to cuts at the federal level is replicated in the states, with massive majorities registering opposition to state Medicaid cuts for nursing homes, even after being told the cuts would help meet balanced budget requirements. Only 15% favored the cuts.

“Voters oppose cutting funding for nursing homes so strongly, they even support additional federal funding to help stave off cuts at the state level,” the Mellman survey report said. “By a 62 to 28% margin, voters favor additional federal funding for Medicaid. Even Republicans support additional federal funding by a margin of 52 to 36%.”

Human toll

The report said the most effective arguments in cultivating opposition to funding cuts is to focus on the human toll such cuts would take. Forty-one percent of voters find an argument stating that cuts mean lower salaries for skilled facility workers a very convincing reason to oppose such reductions. Forty percent said the same when told the coming baby boomer retirement will put a “severe” strain on these facilities. Forty percent were also convinced by the argument that cuts would force layoffs and reduce the quality of care for residents.

All of this information needs to be carefully, but forcefully, presented to lawmakers. They should understand that supporting Medicaid funding so nursing homes can continue to provide quality care to the elderly does not fall in the same bucket of worms as many other spending proposals. Clearly, there is grassroots support for nursing homes and the residents cared for in them, and that message needs to be brought home.

But all of that is focused on a simple six-month extension of funding increases. There is no doubt the need will remain, and that come next summer, the battle will be waged once again as further extensions, or a more permanent arrangement, are sought.

Alan G. Rosenbloom, president of the Alliance, observed, “The fundamental health policy dilemma requiring resolution is the fact Medicaid is almost wholly dependent upon Medicare and other funding sources to augment its increasing inability to adequately serve vulnerable populations in need of care. Coupled with federal Medicare cuts and regulatory changes totaling nearly $27 billion in funding reductions over 10 years, there is no light at the end of the tunnel for seniors and those who provide their care.”

The National Association of State Budget Officers, Rosenbloom noted, recently reported states face a collective $55.4 billion shortfall in fiscal year 2011, and a combined $136.1 billion in deficits over fiscal years 2010 to 2012. “This is simply not an eldercare financing crisis that can be papered over or pushed to the policy back burner,” he said.

Clearly, it is not going to go away.

Bob Gatty has covered governmental developments of the trade and business press for more than 30 years. He is founder and president of G-Net Strategic Communications, Sykesville, Maryland. Long-Term Living 2010 August;59(8):14-15

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