Republicans are still trying to figure out how to repeal the Affordable Care Act. Many hope to phase out Medicaid, which covers poor women and children, the disabled and an increasing number of seniors. For political reasons, conservatives seem to be taking aim at the 15 million people of working age and above the poverty line who came into Medicaid under the Affordable Care Act.  We can all agree that Medicaid should be reformed, but few people realize that it’s a major funder of long-term care services for seniors.  Though it was never intended to cover long-term care for everyone, it now pays nearly 40 percent of those expenses, and the share is growing.  In fact, experts expect Federal Medicaid spending on long-term care to grow by 50 percent by 2026.

In 2012, I took charge of the life of an uncle of mine who was suffering from advanced Alzheimer’s disease.  Within two years, I watched as his life savings flow from his bank account to all the providers of his care. Without the safety net of our family’s resources, my uncle would have needed Medicaid to pay those costs, even though he’d never before received public assistance.

The problem is that our politics and healthcare funding have not accounted for our increasing life expectancy and the increasing periods of infirmity in our lives. For example, while only ten percent of people age 65 suffer from Alzheimer’s disease, those 85 years and older have about a one in four chance of requiring full-time care because of it.  And those living to 85  and beyond are the fastest growing segment of our population.

The simple truth is that Medicaid and unpaid family caregivers (mostly women) are keeping many of the country’s impaired seniors from falling into destitution. Yet, as Dr. Joanne Lynn of the Altarum Institute told me: “Three million women come to their own retirement without ever having had the ability to save a penny. Forty percent of elderly women have no family to rely on and many will have spent all their savings on their deceased husband’s care.”

Moreover, the Alzheimer’s Association estimates there are 15 million unpaid family caregivers who provided 18 billion hours of care valued at least 230 billion dollars on Alzheimer’s alone. When all those in need of care are considered, including those with heart disease, cancer, and severe arthritis, the number jumps to 40 million people.

These numbers show the cost and sacrifice absorbed by American families when it comes to caring for our elderly. Luckily, there are bright spots. Hawaii just passed a law that would grant family caregivers a stipend to offset their costs and burdens. The Kupuna Caregiver Assistance Act (HB607) establishes a program to assist community members, who are providing care for elders, to stay in the workforce. The program will provide a voucher of up to 70 dollars per day to secure elder care support services, such as adult day care, nursing or transportation. But this is just one small step; we need more.

Ai-en Poo, co-director of Caring Across Generations says:

Many working caregivers find themselves in the impossible position of having to choose between caring for their families and keeping their jobs. But this choice is a false one…

Thanks to the efforts of advocacy organizations like Ms. Poo’s Caring Across Generations, there are solutions being hatched to address our dramatic demographic shift. However, the number of persons aged greater than 80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030. We’re running out of time to figure out how to address the cost burdens this will bring.

To be sure, state-based initiatives, like the one in Hawaii are promoted by the Graham-Cassidy Bill and will play a role. But, even the Federal Government has shown it can innovate to control costs.  In 2015, it created the Money Follows the Person Program to shift more money into Home and Community Based Services, rather than the more expensive hospital or nursing home-based care in several states. However, Money Follows the Person would be cut drastically or even eliminated if Congress repeals the Affordable Care Act.

believe the challenge of caregiving may be our best hope to bring about political bipartisanship. The issue involves 40  million family caregivers from both political parties and all income levels. We can’t afford to let Medicaid spending spiral out of control, but we can’t afford to leave it up to the states alone. It’s our nation’s moral duty to never abandon the nation’s aged — or their caregivers.

Posted by Jennifer Brokaw

Dr. Jennifer Brokaw worked for fourteen years as a board-certified emergency physician before becoming a private consultant, patient advocate, writer, and speaker on the topics of end-of-life planning, medical decision-making and medical advocacy.

One Comment

  1. Hi Jennifer!

    Thank you for writing such an informative writing. It surely increased my knowledge.


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