Remove Safety Net And We All Crash

What do middle-income Americans care if Republicans in Congress cut holes in the nation’s social safety nets? We’re not poor. We have jobs. We’ll be fine.

Guess again.

Suppose you grow old. Suppose modern medicine keeps you alive so long you need to enter a nursing home.

Medicare does not cover nursing homes. All but the richest nursing home residents rapidly spend themselves into poverty. Only then do they land in a safety net: Medicaid, the health care program for the poor. Medicaid does cover nursing homes.

Aha, say reformers. Maybe those ex-middle-income people on Medicaid have middle-income children who could pay the nursing home bills instead of Uncle Sam. So, the Republican budget authorizes states to extract nursing home costs from middle-income Americans whose parents are on Medicaid.

Do you want your children to be forced to pay your nursing home bills? If the GOP has its way, your nursing home could drain your children’s finances just as rapidly as it had drained yours - taking money intended for your grandchildren’s college education and your children’s own retirement.

This is nuts. Politically, it’s a recipe for intergenerational war that older people would lose. It also means costly collection headaches for the states. In 1983, when Idaho tried to squeeze nursing home bills from the offspring of Medicaid patients, it met fierce resistance - none fiercer than from the children of abusive parents.

Sure, some people do accept responsibility for their parents’ care. Some can’t. And some won’t, mandates notwithstanding. The fairest, most affordable way to cover the cost of nursing home care is at the national level by spreading the cost across all Americans. Then, nobody gets hounded and gouged by state bill collectors because his or her mom was unlucky enough to suffer from Alzheimer’s.

Certainly, there are ways states can cut Medicaid’s costs. For example, it’s both cheaper and better to keep some elderly folks at home or in an apartment by hiring a visiting nurse.

Congress should give states freedom to innovate in how long-term care is delivered. But the funding must continue to come through taxes - not collection agents - as an expression of our national commitment to the elderly. As individuals, not everyone has, or can afford, that commitment. But as a humane society, it’s a commitment we have to maintain. All of us hope never to need Medicaid, but for many, that day will come.

, DataTimes The following fields overflowed: CREDIT = John Webster/For the editorial board