May 12, 2005

Compassionate Conservatism

Rep. Phil Gingrey (R-GA) just said, in a spech introduced as an indication that Republicans do so care about the health care problems of those hurt by circumstances beyond their control, that they expected to cut Medicare by $10 billion over the next 5 years. He said that worked out to about $2 billion a year, but he thinks that they can find that savings almost entirely out of "waste, fraud, and abuse." He described that abuse as including "inapproriate" nursing home spending, caused by people shifting property to other family members, that takes money away from "the little infants that are born prematurely."

Maybe Gingrey was referring to people who give their house to a relative because owning one can disqualify a person from Medicaid, which is particularly cruel to the elderly. Some senior couples used to be forced to choose divorce over losing everything they'd accumulated over their working lives due to an illness, a situation Congress addressed in a 1988 law, and which perhaps Rep. Gingrey would like to roll back or decrease exemptions for. Indeed, even under that 1988 law change, it would be exceptionally difficult for a couple owning a house in more expensive cities where property values may have doubled, tripled, or perhaps increased even more to keep a home they bought when they were younger:

... How many times has a client said, "I don't want the state to take my house," when a catastrophic illness mandated long-term care for his or her spouse? Many clients wrongly believe that they must sell their houses to pay for long-term care. Under the Medicaid Catastrophic Coverage Act of 1988, 42 U.S.C. 1396r-5 (MCCA), however, a middle class married couple has a short-term planning option when one spouse becomes institutionalized. In essence, the MCCA allows the noninstitutionalized spouse (the "community spouse") to keep the couple's house, car and personal property and a portion of their combined countable assets in excess of program asset limits while the institutionalized spouse receives Medicaid. Congress intended the MCCA rules to provide a uniform national set of income and eligibility criteria. Nevertheless, states enforce them differently. The thorough lawyer must consult the applicable rules in her or his jurisdiction before counseling a client on these complex and difficult rules.

... Under the pre-MCCA rules, to qualify for Medicaid an individual had to be "medically needy" under 42 U.S.C. 1396a(a)(10) and meet established income and resource guidelines. Congress required that states give Medicaid benefits to eligible persons after taking into account only the income and resources that were available to the applicant. Schweiker V. Gray Panthers, 101 S. Ct. 2633(1981). Accordingly, when spouses applied for long4erm care under Medicaid, states typically counted all of the income and resources held in an institutionalized spouse's name toward his or her eligibility.

... These' rules created an economic "feast" or "famine" situation f6r a community spouse. A community spouse experienced a "feast" if he or she held title to all of the couple's income and resources. Under the rules in effect at the time, because of his or her technical separation from the institutionalized spouse, the community spouse was under no obligation to use her or his income and resources to assist the institutionalized spouse with medical costs. As a result, a community spouse could continue to live at the same standard to which he or she was accustomed and avoid the overwhelming financial burden of long4erm nursing home care.

On the other hand, a community spouse found himself or herself in a virtual "famine" if all of the couple's income and resources were held in thename of the institutionalized spouse. In these cases, the state would consider most income and all resources as available to meet the institutionalized spouse's medical needs. No resource diversion occurred between an institutionalized spouse and a community spouse. The states allowed a modest income diversion from the institutionalized spouse to the community spouse, but only at a welfare standard. In these cases, the cost of medical care for the institutionalized spouse exhausted the couple's lifetime savings.

... As both of these situations became more common, Congress, through the MCCA, modified Medicaid to prevent the feast and famine situation and to implement a fairer and more just pro-gram. To prevent feast situations, Congress allowed for greater deeming capability from the community spouse to the institutionalized spouse by placing maximum limits on the amount of resources a community spouse could protect To avoid the famine scenario and the subsequent impoverishment of the community spouse, Congress allowed the diversion of income and resources to the community spouse in the form of a Community Spouse Resource Amount (CSRA) and a Minimum Monthly Maintenance Needs Allowance ...

Or maybe he was referring to people like Shawn Vickers:

... If you ask Rep. Rachel Storch, Vickers is a good example of why the impending Medicaid cuts are wrong and why not all recipients are the cheats some might believe them to be.

The St. Louis Democrat read from a letter Vickers had sent her and other lawmakers:

"They are trying to make me look like a fraud and then imply that the rest of the ... people who will be dropped from Medicaid are also frauds," Storch read.

But for Springfield Rep. Brad Roark, Vickers embodies the very problem with the government program for the disabled and poor.

"The taxpayers of this state are the ones who pay the Medicaid bill ...," the Republican lawmaker said, arguing that recipients' financial records should be reviewed.

Vickers, a 33-year-old hemophiliac who is a constituent of Roark, found out when he was 15 that he had contracted the human immunodeficiency virus and hepatitis C from a tainted blood product he was given.

He went on to earn a college degree and begin a career. But he eventually quit working full time because of his illnesses, he wrote in the letter Storch read on the House floor.

Now Vickers takes $2,100 worth of drugs each month to stave off AIDS. After a $50 monthly premium he pays, Medicaid picks up the rest, he said Thursday by telephone.

But under recently approved legislation and the budget that takes effect July 1, Vickers will have to spend more than half his $1,100 monthly disability income on medication, he said.

Roark, responding on the House floor to the letter Storch read, said Vickers was making $800-a-month payments on a one-bedroom house for which he paid too much. ...

Can't you feel the compassion just oozing off these Republicans like a fresh draught of virgin snake oil?

How can anyone possibly begrudge someone the money to pay for a very modest home, call them a cheat, and push them farther towards a state of total dependence on charity for which they will then probably be blamed? How can the members of a political party do that and then say that they care about people's health?

Posted by natasha at May 12, 2005 02:00 PM | Health/Medicine/Health Care | Technorati links |

I wish the state was giving me that much. I get $320 a month in cash, $130 a month in food stamps, and Medicaid.

I'm barely surviving.

I don't think everyone should have to live at my level. Most people couldn't. Most days I don't think I can, especially towards the end of the month when I have no food or no money for something as simple as toilet paper.

"The Taxpayers" used to be me. When I was working. Now that I'm not working, everyone conveniently forgets that I paid into the system. Even if I hadn't, it's inhumane to treat people the way I've been treated.

Republicans may be sick and wrong, but Democrats aren't much better. The biggest difference I see is which one wants me to die fastest with the Republicans leading the pack.

The way we treat the poor and sick in this society is disgusting. Something needs to be done. We're dying out here.



Posted by: Hanna at May 12, 2005 03:41 PM

Its worse becuase in Georgia the republicans tried to kick 1700 old "rich" folks out of nursing homes, but Gingrey is a physician. He was a part of the frausd and waste.

Posted by: Dave at May 12, 2005 04:05 PM