As is a majority of the country, I am watching with great interest the development of President Trump and the Republican party’s proposal to repeal and replace Obamacare. As an eldercare attorney focused on helping families figure out how to pay for long term care, someone asked me the other day how would the new Republican health care bill (the American Health Care Act or not surprisingly being nicknamed “Trumpcare”) would affect Medicaid coverage for long term care.
While it is too early to say for certain since the details of the proposed bill were only made public a few weeks ago, the speed with which Republicans will attempt to get the law passed is troubling. As with any bill, changes are often introduced during the process of gaining the votes necessary to get it passed, although Republican party leaders say they intend to get the new law passed in about 4 weeks. Who knows what those changes might look like? Nevertheless, we can certainly consider the details that have been announced so far and project how things might play out.
My initial response to the question of how it would impact long term care is similar to my answer when asked about Obamacare when it was initially proposed. Obamacare didn’t change Medicaid’s long term care coverage and nothing I have read about Trumpcare so far has made me think any differently. Obamacare and Trumpcare are about getting uninsured Americans health care coverage, not long term care coverage.
Health insurance doesn’t cover long term care. It covers medical treatment for illnesses that require acute care. As I often explain to seniors and their families, Medicare covers you if you are able to get better. It doesn’t cover long term custodial care – at home or in a facility – that is required because of old age or conditions such as dementia, Alzheimer’s Disease, Parkinson’s Disease etc. People suffering from these conditions often require assistance performing activities of daily living (walking, bathing, dressing, toileting and eating). In the private sector long term care insurance picks up where health insurance leaves off. In the public sector Medicaid’s long term care coverage picks up where Medicare stops.
So, while it doesn’t appear that Trumpcare will directly affect long term care coverage under Medicaid that isn’t to say that older Americans won’t feel the pain of Republicans’ rollout of its new health care plan if it is passed as currently outlined. Next week I’ll talk more about what kind of pain.