Gene Hackman’s death casts a spotlight on aging, caregiving and the gaps in the healthcare system for people who require higher levels of care. There is a critical need for eldercare as well as support for caregivers. With Medicaid, in particular, a likely target for the Trump administration and Republicans in Congress intent on decreasing the budget deficit, there’s a risk that even more Americans will fall through the cracks when it comes to obtaining the care they require.
Hackman, 95, died last month as a consequence of cardiovascular disease, with “advanced” Alzheimer’s disease being a “significant factor.” His wife and caretaker, Betsy Arakawa, died a week earlier as a result of hantavirus pulmonary syndrome, a deadly virus transmitted to humans through contact with infected rodents. Once Arakawa succumbed to the virus she contracted, there was no one to care for Hackman. He seems to have spent the last seven days of his life alone.
While people like Hackman could have afforded additional caregiver help, many Americans can’t. They must turn to insurers such as Medicaid to help provide services and defray costs.
Established in 1965, Medicaid is the joint state and federal health insurance program largely for people with low incomes. Currently, approximately 72 million people are enrolled in Medicaid. It’s hard to overstate the importance of Medicaid. The program covers more than 40% of all births in the country, and nearly two-thirds of nursing home stays.
Medicaid also provides coverage for certain non-medical home care services. However, the specifics, such as eligibility requirements, vary substantially state by state. Medicaid often covers services such as helping with household tasks like cleaning, laundry, meal preparation and housekeeping; temporary relief for primary caregivers; personal care, which includes assistance with activities of daily living such as bathing, dressing, grooming and bathroom needs; supervision; and companionship for individuals.
For people requiring in-home caregivers, the alternatives to Medicaid include expensive out-of-pocket private pay or coverage through long-term home care insurance, the Veterans community care program and Medicare Advantage plans, which sometimes offer limited home care services.
House Republicans passed a budget plan last month that seeks to extend tax cuts enacted in 2018 and reduce healthcare spending by $880 billion, with Medicaid a probable candidate for cutbacks. The House proposal is estimated to save $1.9 trillion dollars over 10 years. While there are sometimes conflicting messages among Republican lawmakers as well as the Trump administration, Medicaid appears to be the most probable major target of budget austerity measures. For every dollar a state spends on Medicaid services, it now gets between $1 and $3 of federal support. Wealthier states are closer to $1; poorer states, $3. It’s these supportive expenditures that could go under the knife.
GOP legislators say their aim is to eliminate waste, fraud and abuse. But Republican legislators are also considering slashing federal matching to save money. States that implemented Medicaid expansion starting in 2013 — a provision under the Affordable Care Act — received a matching rate of 100% through 2016 for certain newly eligible individuals. Beginning in 2017, the rate declined each year until it reached 90% in 2020. Going forward, Republicans want to substantially reduce federal monies allocated to states to support expansion, reverting to the pre-ACA rates of between 50% and 83%.
KFF posted an analysis which found that between 15 million and 20 million people could become uninsured if the federal match rate of 90% reverted to the rates that existed prior to the ACA.
Furthermore, depending on the details contained in the ultimate spending bill that gets passed in the Senate, the legislation could also replace the current funding system with block grants in which states would be either given a capped yearly lump sum of money or an annual upper limit on federal payments per Medicaid enrollee.
In the end, some individuals who are in need of nursing home or in-home care could be in danger of losing Medicaid coverage unless states fill the void left by federal cutbacks. But this isn’t feasible for quite a number of states given the shape their finances are in.
As a result, many Americans simply won’t be able to afford the cost of caring for an aging loved one. The affordability issue will only get worse as the Baby Boomer generation ages.
The budget reductions would place a burden on caregivers and relatives, too. Invariably, this would take a toll on caregivers, especially as they age themselves. Some won’t be able to work, or if they do, they may have to hire health aides due to the aging or disabled family member who needs daily care.
Emma Heming Willis, the wife of Bruce Willis, who is suffering from frontotemporal dementia, used the example of the deaths of Hackman and Arakawa to point out that caregivers need help, too. Their wellbeing can’t be ignored, as they struggle to provide care for their loved ones. They can’t do this work alone.
This problem of inadequate support for caregivers is magnified for people without the financial means to obtain in-home assistance. In turn this raises the question, who will pick up the slack it the federal government pulls back its funding of Medicaid?
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