Brendan W. Williams

In March 2015, President Donald Trump, on Twitter, stated, “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.  Huckabee copied me.” 

Looking for New Hampshire votes at the time, canvassing a state with the second-oldest population, Trump went on to win the Granite State’s primary in February 2016.

Yet Trump’s latest budget proposal would cut over $2.3 trillion dollars from those programs.  It is but the latest in a series of recurring attacks upon the safety net by his administration.

Even as we look toward a wave of seniors who will need services, we are no closer to seeing real federal leadership on the needs of our aging population, despite the welcome integration of long-term care in the “Medicare-for-All” proposals in both the U.S. House and Senate. Those proposals are, of course, dead-on-arrival – even the Democratic votes would not exist to pass the House bill.  Still, at least they advance the conversation.

In the near-term, we must look to the states for leadership. In the state of Washington, for example, legislation to create a state-sponsored long-term care benefit is on the move, after AARP – at the last minute – torpedoed a similar effort in 2018. As the bill’s intent section notes, reality dictates that “[s]eniors and the state will not be able to continue their reliance on family caregivers in the near future. Demographic shifts mean that fewer potential family caregivers will be available in the future.”  A new payroll tax would begin January 2022 to fund the benefit.

Having advocated such a measure in 2011, I’m happy to see Washington make progress, but worried for the rest of us. I can readily imagine a situation where progressive states address this looming demographic crisis, easing pressure upon Congress to come up with a national fix. A New York legislator, for example, added long-term care into his single-payer bill. 

The national economy is strong enough to allow states to be proactive in Medicaid funding, but most still are not.  In South Dakota, for example, it has taken a wave of nursing home closures for legislators to react and come up with a 10% funding increase.  Credit goes to a new governor, Republican Kristi Noem, who inherited the crisis and has acted with speed in addressing it.

But Gov. Noem is the exception, not the rule. In Alaska, for example, a new Republican governor’s budget proposal for 2019 would reduce Medicaid spending by 33 percent – the head of the trade association for hospitals and nursing homes accused the governor of a “‘willingness just to make Alaska a poorer and less safe place.’” 

In Missouri, the Republican governor commissioned a study that suggested a $270 million cut to nursing home care.  Where would displaced residents go? After all, in 2017, $50 million was cut from in-home care as well, leading home care recipients to reportedly worry they would have to go to nursing homes. Budgetary cruelty, it seems, knows no logic.

If state solutions are to be found, advocates will need to get out of their silos and work together. Last year Maine rejected a measure that would have just created a home care benefit — even the eventual Democratic victor for governor opposed it. Yet in New Hampshire there is a bipartisan bill to invest in the entire Medicaid health care workforce. Nursing home advocates are working alongside all others, including those advocating for in-home care for those with developmental disabilities, to fund the entire spectrum of care.

This sort of unity is more necessary than ever.  In too many states long-term care faces an existential crisis.  And states will have to go it alone, for the time being.

Brendan Williams is the president/CEO of the New Hampshire Health Care Association.