Republicans are often characterized as insensitive to society’s poor and most vulnerable. Politics in our state have proved otherwise, however.
Our Democratic governor, Gary Locke, engages in considerable rhetoric about "priorities of government," but governance by sound-bite has not been without its victims. Gov. Locke has made it very clear that while subsidizing airplanes might be a priority of his government, paying for the care of our state’s most vulnerable citizens is not.
In successive years, Gov. Locke proposed Medicaid cuts to nursing home care that would have totaled over $70 million apiece, even though the state itself acknowledged that it was already falling tens of millions short of covering care costs for the two-thirds of nursing home patients on Medicaid.
Last year nursing home advocates suggested that the state utilize a provider tax mechanism under federal law that allows states to assess a fee or tax upon health-care facilities, invest the revenue into care, and draw new federal matching funds. Washington had been using this funding device for intermediate care facilities for the mentally retarded since 1992. It is a remarkable notion: Tax businesses to save them!
The Republican Senate in 2003 agreed to the fee idea, and proposed returning much more fee revenue to nursing homes than House Democrats did, even though the House budget would also have relied upon hundreds of millions from other new taxes they proposed. House Democrats would have, for example, afforded public employee pay increases by doing a markedly worse job of paying the bills for nursing home care.
Neither the House nor Senate followed advocates’ request to use the fee revenue entirely to produce new nursing home funding, as Oregon had done with its new nursing home tax in 2003. In Washington the revenue was largely dedicated to "buy back" Gov. Locke’s proposed cut. In addition to buying back a cut proposed nowhere else in long-term care, nursing homes paid for their own one-time 3 percent Medicaid funding increase. Yet it is important to note that House Democrats had to yield to the strong demand of Senate Republicans to do more by nursing home care, and, with the state budget reeling from lost revenue, the new fee produced immeasurably better results than Gov. Locke’s disastrous nursing home cut would have.
Moreover, our story has a second part.
Turn the page to 2004. Eleven nursing homes have announced closures in just the past year, a loss of more than 1,000 beds, with no new beds since 1995. Through at least June 30, 2005, state "reimbursement" is still based upon 1999 costs, and, as injuriously, 1999 occupancy. On top of this, Gov. Locke began the current legislative session by proposing to account for $11.3 million from the already-inadequate nursing home appropriation as a "savings," a total diversion of $22.6 million with lost federal matching funds.
Unfortunately, House Democratic leadership agreed to this, which creates a jarring dichotomy given that House Democrats showed commendable compassion to the lightest-care population in long-term care, those served in-home, by voting to increase their funding by more than $47 million (something Senate Republicans also agreed to). Thus, for the second straight year, Democratic leadership conceded the role of championing our state’s most truly vulnerable adults to Senate Republicans, and Republicans again came up with a budget preserving nursing home care funding.
The importance of this can be illustrated through example. Bethany of the Northwest, owned by 29 Lutheran churches, is our state’s largest nonprofit skilled nursing care provider, with two Everett nursing homes that can provide care to 231 patients. This year, Bethany has budgeted for a $1.2 million Medicaid payment shortfall. Gov. Locke and House Democrats would do nothing to ease the unsustainable burden upon our private-paying patients to make up for this shortfall, and yet accuse Senate Republicans of neglecting the poor. Reality does not match the rhetoric.
Founders of the Medicaid program, Democrats, under the weight of budget pressure from various interest groups, have seemingly lost their moral compass when it comes to paying the bills for the more than 12,000 largely invisible, debilitated Medicaid patients in nursing homes. Democratic leadership would tax these sick citizens while also cutting their care funding. Meanwhile, Republicans have again demonstrated that conservatism can, indeed, be compassionate.
Tom Gray is executive director of the Everett-based Bethany of the Northwest.
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