Congressional Democrats warned Thursday that financial peril awaits the spouses and children of nursing home residents if Republicans, especially those in the House, push through their version of Medicaid reform.
While much of the debate over Republican health care proposals has focused on Medicare, the government's primary health care program for the elderly, a second wave of anxiety is arising over a separate GOP blueprint for overhauling Medicaid. The Medicaid program provides health care to the poor and disabled and pays costs for most of the elderly Americans who live in nursing homes.
As Congress struggles to complete its plan for balancing the federal budget over seven years, opposition is growing to several elements of Medicaid legislation, especially a provision that could require elderly Americans virtually to bankrupt themselves to obtain subsidized nursing home care for their spouses.
Other provisions of the Republican plan would allow states to put liens on the houses of Medicaid nursing home patients and make adult children financially liable for their parents' nursing home care.
The measures are part of GOP plans to transform the $160-billion Medicaid health care program by ending the federal guarantee that all eligible Americans get care and by giving states lump-sum grants along with the authority to design their own programs and determine eligibility.
Republicans argue that those steps are necessary to their drive to shift power from the federal government to the states.
Democrats contend that current federal protections are needed to keep states from pushing the relatives of nursing home residents into poverty.
"Most people did not really believe these kinds of Draconian cuts were really going to come," Sen. Patty Murray (D-Wash.) said at a news conference Thursday.
Murray said her office is being swamped with calls from worried constituents. "The public is beginning to understand [that] this does not affect just a few people, but every American family."
Seventy percent of the more than 2 million elderly Americans living in nursing homes rely on Medicaid to cover their costs, which average $38,000 a year.
Perhaps the most contentious provision is a House Republican plan to eliminate a law that shelters the last $15,000 of savings and $1,230 of monthly income for spouses whose husbands or wives require nursing home care. Until a couple draws down to that level, they generally are not eligible for Medicaid and must pay the costs of the nursing home care.
That provision, known as "spousal protection," was added to Medicaid in 1987. Until then, states set their own income provisions. Under state laws at the time, spouses were allowed to keep an average of just $2,700 in savings and had to contribute all but $340 of their monthly income to pay nursing home costs.
The Senate Finance Committee has voted to retain the spousal protections, but House Speaker Newt Gingrich (R-Ga.) has declared his determination to continue working to drop the protection.
Both the House and Senate Medicaid reform plans include provisions that would allow states to hold adult children responsible for the costs of keeping their parents in nursing homes. Under laws on the books in 29 states, including California, that would take effect if the Republican plan passes, adult children would become responsible for contributing at least a portion if not all of the cost of their parents' care, Murray said, quoting a legal journal.
Adult children have not been required to contribute to the long-term care of their Medicaid-eligible parents since the program began 30 years ago.
President Clinton repeatedly has spoken out against the Medicaid changes, including a provision in the House proposal that would permit states to put liens on houses of nursing home residents, even if their spouses or dependent children are living in them. The Senate has dropped that element from its plan.
"Who wants a Medicaid police with vast power to seize your assets and put you out of your home," Clinton said during a radio address 12 days ago. "I don't think it should be a precondition that, if a husband has to go into a nursing home, his wife has to go into the poorhouse."
The remarks drew a sharp response from Republican governors.
"As a former governor, you have called into question our dedication to protecting the most vulnerable of our citizens," 22 Republican governors, including California Gov. Pete Wilson, said in a letter to the President last week.
Taking issue with Clinton's "assumption that states would throw people out of their homes," the governors noted that 36 states have spousal-protection provisions that are more generous than federal requirements.
"We find your outrage and distrust of states extremely difficult to understand," the governors said.
But Democratic senators charged Thursday that the governors are not being honest. Why, the Democrats asked, would states press Congress to strike the protections if they do not intend to increase the costs for spouses and grown children of nursing home patients?
Sen. Barbara A. Mikulski (D-Md.), who was an initial sponsor of the spousal-protection provision, said that since it was enacted, 450,000 spouses of nursing home patients have benefited.
She called it outrageous that Republicans would try to turn back the clock to the days when women were left with nothing when their husbands went into nursing homes and some couples were forced to divorce to protect the financial security of the spouse who stayed at home.
"This is why we will fight to the end" to maintain the spousal protections, she said.
Murray warned that it "will be catastrophic to family budgets" if adult children are forced to pay for their parents' care in nursing homes.
This would present working families with difficult choices--like trying to decide whether to spend all their money on nursing home bills or quit jobs to care for sickly parents.
"We are not going to allow our American families to go bankrupt," she added.