WJLA explains how TrumpCare’s Medicaid cuts will negatively affect nursing home residents.  According to the Congressional Budget Office, the American Health Care Act (AHCA) will cut Medicaid spending by $880 billion.  There are nearly 70 million Medicaid enrollees nationwide. The annual long-term service and support spending for Medicaid annually is $152 billion, according to Medicaid.gov.

Nursing facility care is a mandatory entitlement within the Medicaid program. All individuals who qualify financially for Medicaid and qualify by level of disability for nursing facility care must be allowed to receive nursing facility services.

If the cost for care rises or there are more enrollees in the Medicaid program in need of nursing facilities than the state could be without funds to provide nursing facilities to make these accommodations. This can create hurdles for Medicaid recipients currently in nursing homes if the cuts result reduced options for care or loss of care all together.

A report issued by the Henry J. Kaiser Family Foundation echoes that concern.

“States with costs that exceed the cap for their senior or disabled enrollees would need to find other revenues to maintain coverage, or reduce costs,” the report said.

“Republicans have now made the bill even more costly and cruel to American families, likely resulting in millions more Americans not being able to afford coverage. The American people have a right to know the full consequences of Trumpcare before their representatives vote on it,” House Minority Leader Nancy Pelosi said in a statement.

 

New York Attorney General Eric Schneiderman tells Erin Burnett he’s planning a lawsuit should the legislation be signed into law.

“If they pass the bill in the form the House passed it, it is unconstitutional,” he said on CNN’s “Erin Burnett OutFront.”
Calling it “bad public policy” that will ultimately “cost millions of people health care,” Schneiderman takes particular issue with the impact the bill will have on women. “This is an effort to cut off funding for breast cancer screenings, education on sexual-transmitted disease,” he noted, adding that “it imposes an undue burden on women’s constitutional rights.”

The Minnesota Star Tribune reported the tragic case of Allene M. Hookom who suffered severe burns and died after falling into a tub of scalding laundry water, according to a state Health Department report that faults the home’s staff for leaving a laundry door open and unattended.

A week before the incident, a family member spoke to a facility representative about Hookom’s safety in connection with her wandering. The family member said “the facility assured her the resident was still appropriate to live there and she would be safe,” the state report read.

Hookom, who generally relied on a wheelchair to get around, was spotted three times that day approaching the end of the hall where the laundry room was and was sent away each time.

Eventually, Hookom walked through the laundry room’s unlocked door and ended up on her back in the uncovered concrete catch basin, where hot water drains from a washer hose.

A nursing assistant found an alert Hookom face up in the accumulating hot water about 3 p.m. and heard her faintly calling for help.

Hookom suffered second-degree burns to her back, waist, buttocks, legs, ankles and feet, leaving some of her skin bright red and peeling. The water was kept at that 155-degrees to disinfect the laundry. She died the next afternoon at Hennepin County Medical Center.

State Health Department investigators found that the operators of Auburn Manor were negligent when the 90-year-old resident, known to wander unsupervised throughout the facility, ended up on her back in a few inches of 155-degree waste water on Dec. 31.

 

The state is now investigating a local nursing home days after a Channel 9 investigation exposed allegations of abuse. [Nursing home faces lawsuits after employee pleads guilty to sexually assaulting patient].

The Channel 9 investigation aired Thursday and by the weekend, state investigators were at Lake Park Nursing and Rehabilitation Center in Indian Trail. Eyewitness News anchor John Paul went back to the facility looking for answers.  Paul talked to new family members who said they’re concerned about some of the conditions they’ve witnessed there.

Before this investigation, two lawsuits were filed on behalf of residents who are now deceased. The suits alleged sexual assault, poor treatment and untimely death.

According to Nursing Home Compare on the Medicare website cms.gov, Lake Park is a one-star facility owned and operated by PRINCIPLE LONG TERM CARE, INC tha tis on the Special Focus facility watch list. On January 15, 2016, the facility was fined $132, 600 and then again on November 2, 2016 for $277,052.

Vox reported that Health and Human Services Secretary Tom Price gave multiple interviews defending the Republican plan to repeal and replace Obamacare.

He repeatedly lied and made false promises about what the American Health Care Act would do.  He told CNN that the bill would “absolutely not” result in millions of Americans losing Medicaid.  (The Congressional Budget Office evaluated a previous version of the bill and estimated that it would cut $880 billion from the Medicaid program.)
He told NBC that the goal of the Republican plan is to “make certain that every single person has health coverage.”  (The CBO also estimates that the AHCA would cause 14 million people to lose their Medicaid coverage by 2026.)
He has described it as protecting people with preexisting conditions and reducing deductibles, while it does neither of those things. (Most midlevel plans sold on the marketplace have significant deductibles, which can be as high as $6,000.)

Nonpartisan analysis of the bill shows that none of these claims is true. The Republican plan would result in millions of Americans losing Medicaid coverage. Passing the bill would reduce rather than increase how many people have coverage.

The most recent CBO estimate predicts that 24 million Americans would lose coverage under AHCA. The majority of those people losing coverage would be Medicaid enrollees, but 2 million Americans would also lose individual plans. An additional 7 million Americans would lose coverage, as the CBO expects the Republican plan would encourage some workplaces to drop their offerings.

NPR reported on the new Propublica investigation into wasted prescription drugs at nursing homes.  Millions of dollars of perfectly useful drugs are thrown away every year instead of being recycled.  In Iowa, they have a program set up to retrieve these drugs and redistribute them to uninsured or underinsured patients for free. And they’re getting about $5 million worth of these drugs this year.

These drugs, experts say, might be wasting hundreds of millions of dollars a year.

 

Conservative writer Andrew Sullivan’s reaction to Trumpcare in New York Magazine was excellent.

“A word on Obamacare. I relied on it until just recently when I joined New York’s staff and went on an employer’s plan, and, to tell the truth, part of me didn’t even want to make the change — even though it will obviously save me a lot of money. What Obamacare did for me, living with the preexisting condition of HIV, was, first of all, give me far more independence and freedom. It gave me the confidence to quit a previous job and start my own little media company — my blog, the Dish. It gave me peace of mind when I subsequently shut that business down and was able to stay on the same plan. It allowed me to be a freelance writer without fear of personal bankruptcy. I got no subsidy, but I was glad to pay the premiums for me and my husband because it gave me a sense of control over our finances and our future. I knew I wouldn’t suddenly find myself facing soaring health-care costs or no health care at all — and the premium actually went down a smidgen last year.

The TrumpGOP’s attempt to abolish it is therefore, to my mind, neither conservative nor decent.

You might think Obamacare would violate my generally conservative principles, but it didn’t. In fact, it seemed to me to be an effective marriage of conservative principles and, well, human decency. The decency part comes from not blaming or punishing the sick for their condition. The conservative part comes from the incremental nature of the reform, and its reliance on the private sector to provide a public good. For good measure, it actually saved the government money, and it slowed soaring health-care costs. The exchanges, with predictable early hiccups, largely worked — a case study in the benefits of market competition. The law allowed for experiments to test how efficient health care could be. It even insisted on personal responsibility by mandating individual coverage. And the concept of insurance is not socialism; it’s a matter simply of pooling risk as widely as possible. If any European conservative party were to propose such a system, it would be pilloried as a far-right plot. And yet the Republican Party opposed it with a passion that became very hard for me to disentangle from hatred of Obama himself.

The Trump GOP’s attempt to abolish it is therefore, to my mind, neither conservative nor decent. It’s reactionary and callous. Its effective abandonment of 95 percent of us with preexisting conditions will strike real terror in a lot of people’s hearts. Its gutting of Medicaid will force millions of the poor to lose health care almost altogether. It will bankrupt the struggling members of the working and middle classes who find themselves in a serious health crisis. It could hurt Republicans in the midterms —though that will be cold comfort for the countless forced into penury or sickness because of Trump’s desire for a “win.” But it’s clarifying for me. It forces me to back a Democratic Party I don’t particularly care for. And it destroys any notion I might have had that American conservatism gives a damn about the vulnerable. It really is a deal-breaker for me. I hope many others feel exactly the same way.”

The D.C. Circuit, divided, ruled for the National Railroad Passenger Corp.—Amtrak—in a dispute over the firing of an officer named Sarah Bryant. An arbitrator said Bryant, fired for misconduct in 2012, should receive reinstatement, with back pay and lost seniority. A Washington federal trial judge later vacated that award.

Bryant, through the Fraternal Order of Police, appealed to the D.C. Circuit. The arbitrator had said the internal investigation violated a part of the collective bargaining agreement that governs interrogations. Two judges on the D.C. Circuit panel, A. Raymond Randolph and Brett Kavanaugh, said Amtrak’s inspector general’s office was not bound by that rule in the agreement.

Judges don’t have much flexibility when it comes to vacating arbitration awards. Randolph and Kavanaugh turned to one rarely used exception—for “public policy.” That exception gives judges the power to strike an award that is contrary to “law or public policy.”  The exception can overturn an arbitration award on grounds that it violates a law or compels an employer to violate a law.

Randolph, writing for the majority, said the exception should be applied in Bryant’s case because the court would essentially be enforcing an illegal contractual obligation. The inspector general should not have been restricted by any rules created in collective bargaining agreements to conduct investigations.

“An arbitration award may not be enforced if it transgresses well defined and dominant laws and legal precedents,” Randolph said in the opinion.

The Intercept had an article on how TrumpCare will affect nursing home residents with Medicaid.  Daniel Webster, a Republican representative from the 11th Congressional District in central Florida, acknowledged this when he announced he would vote for the AHCA. Medicaid pays the bills for over 60 percent of nursing home residents — people who cannot care for themselves and without Medicaid would have literally nowhere to go.

“I have been very concerned about Florida’s Medicaid-funded nursing home beds,” Webster said. “These are critical to the access some of our senior population has to our nursing homes.”

“Many middle-class Americans are unaware that the huge cost of nursing home care – which in some areas can run over $100,000 a year — is not covered by Medicare. Those who need it and cannot pay for it themselves can generally receive coverage from Medicaid, though they usually must spend down all their savings first.”

TrumpCare slashes $880 billion dollars from Medicaid spending over the next ten years, or about one-sixth of the $5 trillion it would otherwise cost the federal government.  The bill accomplishes these cuts by changing Medicaid from an entitlement, in which the federal government automatically provides states with funding based on the needs of their population, to either a block grant or a per capita allocation.  It will inevitably have serious consequences over the next 20 years due to the aging of the baby boom generation.

Nursing care is one big reason Medicaid recipients over 85 cost the program 2.5 times more than those who are between the ages of 65 and 74. If Medicaid were to remain an entitlement, states would automatically receive increased federal funds to cover these greater costs as baby boomers age. Under the AHCA, the per-capita payments to states will increase far too slowly to cover them.

 

With the aging of America comes the constant debate on the issue of stay at-home care verses nursing home care. The Louisiana AARP has strong opinions, claiming we are heading the wrong way.  Listen to the AARP’s Andrew Muhl with WWL’s Tommy Tucker here.  AARP spokesman Andrew Muhl breaks down the finances:

Right now the annual cost per person on average for at-home or community based services is around $18,000 a year,” said Muhl, “while the average cost for nursing home care runs close to $50,000 a year.”

Muhl says stay at-home care is not always possible but it’s by far more popular.

Overwhelmingly, what we’ve learned is that people want to age in place and receive care at home,” he explained. “There is a large majority of people in nursing homes that don’t need 24-7 care, they just need a little care that they can receive at home,” Muhl said.

Unfortunately, Muhl says there are fewer and fewer resources for the elderly who want to stay at home and live independently.