Schools vs. elder care

The continued fall in state revenue is alarming for human services.

With a scant $163 million cushion, our two-year budget may be in the red following September’s revenue forecast.

Starting July 1, the budget compounds its revenue problems through massively de-stimulatory cuts and lay

offs (which the federal government may replicate). We have forgotten the Depression’s teaching of economist John Maynard Keynes that spending stimulates growth. Even President Richard Nixon proclaimed himself a “Keynesian.”

Our state’s most vulnerable residents ride a roller coaster of uncertainty. This uncertainty is compounded by pitting our future — education — against the impoverished in medical need.

The state’s one constitutional spending duty is “to make ample provision” for education. That’s a failed duty the coming gubernatorial race will focus upon anew.

Further, as if burying a jar of pennies expecting to dig up gold doubloons, the 2009 Legislature set the goal of fully funding education reform by 2018. Given this commitment, we can’t keep bankrupting our future through huge cuts in the more-than half of the budget going to K-12 and higher education. But how can we morally neglect those with disabilities who are in need?

By 2030, the proportion of Washingtonians 65 and older will grow from roughly 12 percent today to almost one out of every five residents.

Our state’s population of the most elderly and frail — those 85 and older — has exploded. Between 2000 and 2010, for example, this age group alone grew by 39 percent to 117,271 residents. A 2004 national survey showed this demographic comprises 45 percent of nursing home patients.

Where’s our long-term vision for our aging population’s long-term care needs? Further, how will we avoid conflict between those needs and necessary investments in education?

In contrast to every candidate aspiring to be an “education governor,” no one campaigns to be a “human services governor.”

As U.S. Sen. John Rockefeller IV (D-W.Va.) recently noted, “Seniors vote. But if you are poor and disabled, you might not vote, and if you are a child, you do not vote — that’s a lot of Medicaid’s population. They don’t have money to do lobbying.”

That’s in marked contrast to Medicare, the 65-and-older entitlement that seems the exclusive focus of national debate between the two parties.

Unlike Medicaid, the federal/state safety net for the medically indigent, Medicare is not means-tested. Nor is it, contrary to public misperceptions, really a long-term care program.

While Medicare Part A covers post-hospitalization nursing home stays for those 65 and older, it only pays the entire cost for 20 days. Medicare pays less than one-fifth of all long-term care costs. Medicaid pays around half.

Meanwhile, as Medicare cuts are hotly politicized, the Obama administration quietly accepts Medicaid cuts made by states. It’s even arguing, before the U.S. Supreme Court, such cuts should be effectively unchallengeable.

We’re on a fatal trajectory.

Consider Medicaid cuts already in effect. To achieve a new $98.1 million state cut, sacrificing equal federal matching funds, care was slashed an average 10 percent for in-home clients — with the range as high as 18 percent. That’s tragic. Imagine as many as 23 fewer care hours in a month. What daily living activities would you sacrifice assistance for? Bathing? Eating? Toileting?

Despite accounts of terrible negligence in adult family homes, caregivers will go without voter-approved training to improve quality — a double blow considering clients are making do with less.

The poor access primary care through hospital emergency rooms or community clinics. Both settings took huge Medicaid cuts, with total losses of $221.1 million for hospitals and $86.3 million for clinics.

The sad truth is that we end up valuing criminals more than those with disabilities. The state pays less for most clients receiving 24/7 care, meals and housing in boarding homes — as little as $43.89 a day — than it pays in bed rental rates for community custody violators ($85 a day plus medical costs).

With respect to long-term care, there has been no substantive difference between the two parties’ state budget approaches. At least Medicaid beneficiaries denied hearing aid coverage will no longer hear rhetoric from politicians pretending to care.

Instead the heroes have been judges like two appointees of President George W. Bush — U.S. District Court judges Richard Jones, who blocked adult day health cuts, and Ron Leighton, who blocked nursing home cuts. The Washington Supreme Court saved care hours for kids with developmental disabilities.

In our state, avoiding pitting other funding needs against human services is complicated by a federal Medicaid matching formula, based upon per-capita income, that punishes us for relative prosperity. It doesn’t account for Washington having no income tax.

Every gambit fails to counteract this huge disadvantage. So we build life rafts when we need an ark. A hospital tax failed to preserve funding. Similarly, a new nursing home tax may prove only temporary salvation for roughly 10,000 infirm Medicaid patients.

How many rafts must sink before we take a holistic view of safety-net needs? When will we embrace a vision of the future that looks beyond the next election?

In 1991, state Rep. Dennis Braddock of Bellingham, who would later administer Medicaid under Gov. Gary Locke, proposed a small payroll tax to guarantee long-term care funding. A payroll tax is the means by which we fund Medicare Part A. With a few Republican votes, Braddock’s “secured benefit act” passed a Democratic House, but died in a Republican Senate.

Two decades later, we’re no further along in protecting our most vulnerable. We must resurrect the idea of dedicated funding for their care. It’s simply not enough to posture about “tax loopholes,” like a big bank mortgage tax loophole that should be closed. Closure of loopholes, alone, will not fix structural tax problems imperiling lives and our state’s future.

Call it a “half-cent solution.” A payroll tax of 0.5% of earnings, split evenly between employers and employees (as the 2.9% Medicare Part A tax is), would generate more than $600 million a year for long-term care. Invested in Medicaid, it would draw equal federal matching funds. Because it would be income-based, it would not be the volatile funding source the sales tax is.

Politicians seldom take the long view, but must do so on long-term care. Our most vulnerable deserve more than poll-tested rhetoric. Human suffering is no less significant than the consequences of education cuts just because it’s less tangible. Paying as we go can ensure the safety net is available to all those in need. And by taking long-term care “off the books,” we could free resources for our future educational commitments.

Long-term care advocate Brendan Williams of Olympia is a former Democratic state representative.

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