Financial games will harm elderly

Stuart H. Shapiro is president and CEO of the Pennsylvania Health Care Association and Center for Assisted Living Management, an advocacy organization for the elderly and their care providers

As a young boy, I loved to hustle my friends in games of three-card Monte. I was a master at shifting the cards so smoothly through my fingers that I could trick almost anyone.

Today, I'm watching Congress play a similar shell game. Only now, it's my baby boomer buddies and our "Greatest Generation" who are being swindled by federal deficit-reduction games that do little more than shift costs to state and local governments. And that is a problem for Pennsylvania and New Jersey.

It used to be that statesmen and politicians of all stripes courted this "Greatest Generation" for its standing as the nation's largest and most reliable voting bloc. Now, its members, along with their dignity, are under siege.

This is especially frightening to our most frail and elderly in nursing homes. With policy changes and funding cuts, Congress' sleight of hand is threatening the very programs that these men and women rely on to live a healthy, high quality of life with the dignity and respect they deserve.

For years in Pennsylvania and across the country, Medicaid reimbursements have fallen far short of covering the true cost of care for nursing-home residents. But nursing homes were able to weather the losses because their Medicare payments for short-term rehabilitation patients countered their Medicaid losses for long-term care residents.

But now with Medicare under attack, the landscape has dramatically changed. For older Pennsylvanians and their families, access to nursing home care and the quality of that care is very much at risk.

First, President Obama's federal health-care reform expanded coverage to millions of Americans through extreme cuts in Medicare - $14.6 billion from the care of those in nursing homes nationally over 10 years. Pennsylvania nursing homes' share of this cut approaches $1 billion.

Making matters worse, the Centers for Medicare and Medicaid Services recently announced it was slashing Medicare payments to nursing homes by 11.1 percent - $3.9 billion in one year alone. In our commonwealth, among the nation's oldest states by population, nursing homes will lose up to $300 million annually. New Jersey will lose a similar amount. These draconian cuts in Medicare alone now threaten seniors' care and the jobs of those who provide these services in both states.

Nonetheless, members of the debt supercommittee - including U.S. Sen. Pat Toomey (R., Pa.) - are discussing more Medicare cuts in their quest to identify $1.5 trillion in debt savings. If the committee does not act by Dec. 23, Medicare payments will be cut automatically by an additional 2 percent, costing our commonwealth's nursing homes an additional $500 million.

These daunting Medicare numbers, unfortunately, tell only half the story.

Both the supercommittee and the White House are also looking to find savings from inadequately funded Medicaid programs by reducing the federal matching requirements and almost halving or eliminating "provider assessments" that help 38 states fund, with federal dollars, quality long-term care services for seniors and people with disabilities. In Pennsylvania, that program generates $434 million that directly funds quality nursing-home care, while in New Jersey it provides about $155 million.

Gov. Corbett and the General Assembly prudently made care of the frail and elderly a priority in the commonwealth's 2011-12 budget. And while many think of Medicaid as a health program for the poor, the reality is that the single largest Medicaid expenditure is for long-term care, particularly the sickest, oldest, frailest elderly who live in nursing homes, where the gap in funding between costs and payments for care in Pennsylvania has increased to $19.23 a day, or $7,000 a year.

The message is clear: Any further cuts at the federal or state level to Medicare or Medicaid threaten an already fragile long-term care system with unthinkable and tragic results. Further cuts would place quality of care at risk and very soon limit access to people who need nursing-home care.

Now, more than ever, older Americans need advocates - in Washington and in state capitals - to address the care needs of the first wave of the two million Pennsylvania baby boomers who turned 65 this year. Our social-service safety net, particularly for the frail elderly, is already stretched way too thin. It needs to be shored up, not shot down.

Older Americans deserve better, and the programs they rely on deserve our continued support by both our president and the Congress.

Unfortunately, with the hyper-partisan wheeling and dealing in Washington, there don't appear to be many winning hands in the federal deficit-reduction game. The deck seems to be stacked with trick cards that are likely only to shift the burden, leaving most states, and the residents they care for, empty handed.

Oh, to those glory days of three-card Monte, where the stakes were only a nickel.