The U.S. Reformation on Medicare Programs

The cuts to the Medicare system have decimated the healthcare industry, a sad fact hidden from the average American citizen. In an ill thought out plan, the United States Congress cut 23 billion dollars a year out of the Medicare system over the next five years. Around the country, hospital patients, nursing home residents and home health patients are being denied lifesaving treatment because of insufficient reimbursement by the government. In the wake of news reports of these tragedies, many Congressmen are now calling for a new vote to restore much of what they gutted from the public healthcare system.

At the forefront of the problems that have arisen because of the Medicare cuts is the lack of care for the neediest of our citizens, the elderly. In the United States, close to 40 million Americans are on the Medicare health system, of that number around 75 percent are over the age of 65. At a time when the life expectancy has increased to 78 years old, and medical care presumably is becoming more necessary, should we really be limiting the access to that care? In my position as a paralegal for a major healthcare company I routinely hear of husbands or wives returning to work in their seventies to pay the medical and nursing home costs for their spouses. In a Florida nursing facility, the husband of a resident recently died from malnutrition. He had been working two jobs to pay for his wife”s nursing home care after she had exhausted her Medicare benefits. In an effort to save money, he had been eating dog food for about two months. Two sons of a California nursing home resident each month turn over their social security checks to pay for their mother”s nursing home stay. When asked what they were living on they replied that they had sold both their homes and were living together in an apartment. Both sons were in their sixties, and most likely would need care themselves at some point, who would provide it for them? A nursing home recently sued an Indiana woman for failing to pay them $100,000 for her annual costs.

The woman, penniless was faced with eviction and placement with her son and daughter-in-law.

The first reaction would be to blame the nursing homes for being too expensive. However, even by the best estimates from the government agency that oversees the payment of nursing homes, the Healthcare Financing Agency (HCFA), nursing homes will not be reimbursed at a rate adequate to cover their costs. The government openly acknowledges that nursing homes will lose money on Medicare patients, but those same homes are by law prohibited from turning away a resident because of their inability to pay or because of the payment source. In a letter sent to the state agencies that oversee nursing home conditions, HCFA warns of the financial shortfall in nursing home reimbursement. In an apparent attempt to show healthcare providers that they may face criminal charges for failing to provide adequate care, HCFA has gone after several companies, even after they have gone bankrupt from lack of funds.

Already, only one year after the enactment of the Medicare cuts, several of the nations largest nursing home chains have gone out of business or have left the skilled nursing home business altogether. According to U.S. Senator Edward Kennedy, 10 health agencies have gone out of business since January 1, 1999, in Massachusetts alone. A recent report released by HCFA indicated the mean reimbursement rate would be $300 per resident per day. With an average hourly rate for an LPN at $14 an hour and HCFA mandating a minimum of 4.8 hours of care per day, that leaves only $133 to provide food, shelter, medication, pay support staff and still turn a profit. Is it any wonder why nursing home companies are finding it difficult to make employee health insurance payments?.