In May 2017, Donald Trump’s administration tried to promote the American Health Care Act (AHCA), which had been approved by the U.S. House of Representatives, to replace the Affordable Care Act (ACA), but it was not passed by the U.S. Senate. The AHCA was intended to restructure and limit resources for Medicaid to cover the needs of the elderly by paying for nursing homes and long-term services (Ko et al., 2018). Consequently, a key health issue for older people associated with the possible adoption of the AHCA and its effects on Medicaid could be the worsening of care provided for seniors due to reduced financing for nursing homes and home- and community-based services. Thus, thousands of older citizens in the United States will lack adequate care after this potential restructuring of federal and state Medicaid financing (Solomon & Schubel, 2017). The purpose of this paper is to discuss the literature surrounding the issue and its proposed resolutions, analyze attempts to solve the issue with reference to public policy, identify barriers, evaluate available options for public and private funding, and present recommendations to address the problem.
Evaluation of the Literature on the Solution to the Issue
Limiting care for older people in nursing homes and other facilities because of Medicaid cuts is associated with challenging issues that cannot be resolved easily because of the current administration’s policies directed toward decreasing healthcare costs as much as possible. There are plans to cut Medicaid funding and provisions by more than $800 billion during the next ten years while decreasing patient enrollment by 14 million people (McDonough, 2017). The expected result for older people who rely on Medicaid and/or live in nursing homes is dramatic, since millions of seniors will lack the resources necessary to receive the previously-guaranteed long-term services they require. According to McDonough (2017), even if it is impossible to prevent changes in U.S. health policy and Medicaid cuts are required, alterations should be gradual and less aggressive. Berridge (2018) also agrees that Medicaid cuts need to be carefully planned and organized based on cost analysis in order to decrease negative effects on vulnerable older people within the next few years. Scholars and experts point to the necessity of slow changes in order to resolve the issue.
Although the AHCA was not passed, the issue of decreasing federal funding for Medicaid and promoting budgetary pressure for state-sponsored nursing homes and other facilities for older people is still actively discussed in the scholarly literature. The focus is on proposing a resolution to the issue in terms of reconsidering the role of state and private sponsors in funding services for older people (Collier, 2017; McDonough, 2017). Wen, Behrle, and Tsai (2017) indicate that the role of insurance companies in the process will become more significant as their revised or new insurance coverage will be discussed as alternatives for the elderly. Certain criteria for states to make funding decisions appropriately are also proposed in the literature.
Incorporating the Solution into Public Policy
The public’s attempts to prevent reductions in Medicaid funding and stop the promotion of the AHCA were centralized in campaigns that were intended to persuade the U.S. Senate not to pass the legislation. Some campaigns were aimed at demonstrating the adverse effects of the bill on geriatric care in rural or low-income communities (Solomon & Schubel, 2017). Other proclamations were directed towards finding a compromise and developing a policy that could contribute to decreasing public funding for Medicaid without affecting care for children, people with disabilities, and older persons (Ko et al., 2018; McDonough, 2017). The AHCA is not established as such a policy and activists continue to propose alternative options to Medicaid cuts and restructuring funding with the focus on the role of states in the process.
Barriers to the Implementation of the Solution
The support of the AHCA by the President’s administration and the House of Representatives is the key barrier to the implementation of an adequate solution to the problem of Medicaid cuts that can potentially affect the delivery of healthcare services for older people. Even if the AHCA is not adopted, Medicaid cuts are planned in the budget for upcoming fiscal years in the context of reforming national health policy (Canady, 2018; Knopf, 2017). Therefore, it may only be possible to influence the speed of implementing cuts in Medicaid coverage with a focus on continued financing of nursing homes and other services for older people (Solomon & Schubel, 2017). Despite the fact that the AHCA legislation is viewed by many experts as in effective for replacing the ACA, the risk of decreased Medicaid funding is real and this proposition is supported by many legislators.
Options for Public and Private Funding
It is expected that, after the implementation of significant Medicaid cuts, public funding for nursing homes and services for seniors will be fully controlled by the state. As a result, state officials will decide what healthcare facilities for older people will be funded, what staff must be hired, and what services should be financed (Solomon & Schubel, 2017; Wen et al., 2017). In this context, options for public funding that addresses the issue of limited health care for older people include a focus on effective distribution of financial and material resources by state authorities based on the analysis of trends in healthcare for older people in a certain region. Private avenues of funding that addresses the issue of closing or unfinanced nursing homes are associated with sponsorship and volunteering (Canady, 2018; Knopf, 2017; McDonough, 2017). However, this option is not discussed in the literature as adequate and effective to address Medicaid cuts in the future.
Recommendations
In order to prevent the negative effects of Medicaid cuts on the work of nursing homes and the provision of long-term and home-based care services, it is necessary to adopt policies that regulate what services must be covered by a state and what services can be partially paid by individuals and their family members. The focus on this carefully calculated balance between financing the provision of services by state authorities and individuals is important to prevent staff and resource shortages in nursing homes (Ko et al., 2018; Solomon & Schubel, 2017). Furthermore, much attention should be paid to attracting resources from public healthcare and charity organizations to resolve the problem in order to prevent the elimination of programs associated with home- and community-based services (Berridge, 2018; Canady, 2018). Though these actions are complex, they can be viewed as an effective method of addressing potential Medicaid cuts related to the current administration’s promoted policy.
Conclusion
This paper has presented a discussion of the literature on the health issue facing older people in the United States and the provision of care in nursing homes. The key focus has been on describing the attempts to adopt the AHCA that would have contributed to Medicaid cuts. The resolutions proposed in the current literature have been analyzed in detail. Furthermore, the analysis of possible methods of solving the discussed health and policy issue has also been presented. In order to examine the problem as well as the possibilities for its solution from different perspectives, certain barriers to addressing the issue have been identified. In addition, the paper has presented the evaluation of options that are available for public and private funding in the context of decreasing Medicaid coverage for elderly individuals who require long-term care. Finally, appropriate recommendations for addressing the problem have been proposed.
References
Berridge, C. (2018). Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: Policy analysis. Journal of Medical Internet Research, 20(2), e66-e71.
Canady, V. A. (2018). Trump’s FY 19 budget proposes Medicaid cuts, MH reductions. Mental Health Weekly, 28(8), 1-3.
Collier, R. (2017). Massive cuts to science and medicine in Trump budget. The Canadian Medical Association Journal, 189(23), e812-e813.
Knopf, A. (2017). FY 2018 budget request from Trump: Massive cuts to Medicaid. Alcoholism & Drug Abuse Weekly, 29(21), 1-3.
Ko, M., Newcomer, R. J., Harrington, C., Hulett, D., Kang, T., & Bindman, A. B. (2018). Predictors of nursing facility entry by Medicaid-only older adults and persons with disabilities in California. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 1-8.
McDonough, J. E. (2017). Prospects for health care reform in the US Senate. New England Journal of Medicine, 376(26), 2501-2503.
Solomon, J., & Schubel, J. (2017). Medicaid cuts in house ACA repeal bill would limit availability of home-and community-based services. Center on Budget and Policy Priorities, 1(5), 1-18.
Wen, L. S., Behrle, E. B., & Tsai, A. C. (2017). Evaluating the impact of Affordable Care Act repeal on America’s opioid epidemic. PLoS Medicine, 14(8), 1-10.