Thursday, May 25, 2017

Just Die- Or Stay Home

Everybody plays the fool, no exception to the rule....

Not all fools (almost all, though) are Trump voters and not all Trump voters are fools.

This applies even to the elderly, some of whom are very well off. But this is inapplicable to those elderly or near-elderly who voted for Donald Trump and are not unusually affluent or who don't have offspring willing and able to care for their parents for many years.

The graph below reflects the 2016 presidential election vote based on exit polls. While 18-29 year olds (19% of the electorate) voted 55%-37% for Clinton over Trump and the 30-44 year olds (25% of the electorate) went for Clinton 50%-42%, 45-64 year olds (40% of those voting) went for Trump, 53%-44% and and individuals 65 and older (15%) voted for Trump 53%-45%.

Overall, the relatively young (18 to 44, 44% of the voters) gave Clinton 53% of their vote and Trump only 39% while the relatively old (45 and up, 56% of those voting) opted for Trump by 52% to 44%.

That's a difference of 22%, which in all likelihood would have been even greater had Trump the opportunity to run against Barack Obama.  Yet, those folks in elder care facilities, who have parents in such facilities, or who are (or fairly soon will be) contemplating the possibility of relocation there, are promised a raw detail in the American Health Care Act as written. Jon Schwarz of The Intercept explains

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.

When all is said and done, 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.

But the AHCA 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. (While these seem like enormous numbers, the U.S. economy is so big that even $5 trillion will be just about two percent of the gross domestic product over the next decade.)

The bill accomplishes these cuts in part 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 (at the state’s choice).

The amount states will receive per capita will be set at the average cost for recipients in 2016. It then will increase at the Consumer Price Index’s rate of medical inflation until 2020, when it will begin going up at the CPI medical rate plus one percent. While this sounds reasonable, it will inevitably have serious consequences over the next 20 years due to the aging of the baby boom generation.

This year someone born in 1950 will turn 67 years old, and probably doesn’t need nursing home care. In 2037 they will turn 87, and will be far more likely to do so.

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.

There are many culprits in Trump's victory other than naivete of voters.  Moreover, oldish Americans probably will lead the grass-roots opposition to the AHCA, whether through the AARP or other like-minded organizations, or individually.  Still, this tax cut for the wealthy- uh, er, health care bill- tells us how prescient one ex-congressman was.

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