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Guest commentary / Long-term care


We're not planning for our aging society's future

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By Jim Roe
Published:
As the father of children who are 10 and 12 and in public schools, I was heartened by the Washington Supreme Court's ruling that the state isn't making ample provision for education. My kids are my highest priority, and they're supposed to be my state's too.
As the owner of four long-term care facilities in Anacortes and Bellingham, however, I feel dread knowing an inevitable collision has been accelerated – within scarce state resources – between K-12 education and care for those with disabilities. The court clearly intends the state honor a commitment to basic education requiring additional billions of dollars by 2018. Meanwhile, our society continues to age.
Indeed, a demographic collision is already underway in current state budgeting. For example, within a no-new-taxes construct, both House and Senate Democrats would largely maintain inadequate K-12 funding.
Meanwhile, under their budgets, skilled nursing homes, having volunteered in 2011 to pay an assessment to preserve Medicaid rates, would see that fee soar from $11 to $19 per patient, per day. The assertion is this hike allows Medicaid rates to stay at June 2010 levels. However, that's hard to account for – one Medicaid add-on of $1.57 per day, intended for low-wage workers, would be eliminated and a cut based on medical need would force rural nursing homes to close.
When this fee funding mechanism was used before, a fee of only $6.50 per patient, per day was used to increase Medicaid rates 5.6 percent from 2003-04. That increase was large enough to allow many providers, including myself, to avoid passing the fee itself to patients.
It's not a long-term funding solution to ratchet up fees on those prudent, or lucky, enough to be able to pay privately. Because private-paying patients already cross-subsidize, through higher rates, payment shortfalls for the roughly two-thirds of nursing home patients on Medicaid, higher fees will simply force them sooner into Medicaid poverty.
And what will the answer be in the 2013 session if this assessment is as high as it can go and the Legislature is forced to slash new billions? Will private-paying nursing home residents be both taxed and see their care cut? If so, their plight will be similar to college students who have seen tuition soar along with class sizes.
Nor, however, is the answer the Senate-passed Republican budget that simply leaves a $10.54 million hole in nursing home funding in the budget's remaining fiscal year. It also cuts boarding homes' Medicaid rates by 2 percent.
Sustainable policy would avoid the collision between kids and an increasingly-aged population by finding dedicated funding for one or both groups. This is the conversation we must have. If “demographics are destiny” the destiny of our state is quite uncertain. Surely the measure of a just society is how it cares for those at either end of life's journey. On both counts, our state is failing.
Rhetoric over health care reform ignored the fact that we already, effectively, have a single-payer system, Medicaid, in long-term care – including for roughly 10,000 nursing home patients statewide.
Medicare Part A is funded through a 2.9 percent payroll tax split evenly between employers and employees. So why not have a similar state social insurance tax of as little as 0.5 percent? It would be a consistent way of addressing current Medicaid long-term care funding needs and preparing for the coming age wave. And it would take pressure off K-12 and higher education funding.
A federal “CLASS Act” was supposed to create a social insurance benefit for future long-term care needs – but the Obama administration pulled the plug after seeing its voluntary nature wouldn't succeed. Meanwhile, Met Life is among insurers withdrawing from long-term care (while, as is common among long-term care insurers, raising rates on remaining enrollees by 41 percent).
The legislative session may (or may not) end in March, but our future will not. When will we start planning for it?
Anacortes resident Jim Roe owns four long-term care facilities in Anacortes and Bellingham, and works in one each day as an administrator.

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