Pretending to revamp Medicaid

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John O'Connor
John O'Connor

It wasn't very long ago that senior living operators gave Medicaid nary a thought.

Throughout the 1980s and early 1990s, it generally was regarded as a payment option for nursing home residents who were poor — or at least looked poor on paper. But as we all know, the field has changed a bit since then. These days, just about every state lets Medicaid dollars flow into senior living communities.

From an operator's perspective, this relatively new funding option is not great. But at least it's reliable. Or was.  

For it appears some significant changes may be coming Medicaid's way. And the early betting is that these adjustments are not going to be of the payment-enhancement variety.

Earlier this week, a House Energy and Commerce Oversight Subcommittee started talking about some of the changes that ought to be made, sort of.

If you didn't take in the event, you missed out on quite a kabuki dance. Here's why: Our new president has made dismantling Obamacare one of his main campaign promises. The new health law has poured a lot of new money into the Medicaid program, however, and is on course to keep doing more of the same. That increased funding, by the way, has helped many low-income voters tap into health services that previously were not available.  

So if you happen to be a GOP lawmaker on the subcommittee in question, it would appear you are looking at two fairly uncomfortable choices.

Option One is to support continued increases in Medicaid funding and incur the wrath of what appears to be a very wrathful White House. Option Two is to actively take the axe to Medicaid spending and perhaps incur the wrath of constituents who might hold a grudge when the next election rolls around.

Actually, a third option exists: tread water. In other words, sort of pretend to dismantle Medicaid while doing as little as possible to make that reality occur.

If this week's House subcommittee hearing was any indication, Option Three appears to be alive and well. Did the hearing address block grants, which are the main pillar of the administration's plan for Medicaid? No. Did the hearing talk about repealing Affordable Care Act provisions that expand Medicaid funding? No.

Instead, Republicans on the subcommittee spent a fair amount of time discussing narrower concerns. These included misspent Medicaid funds, patient wait lists and third-party liabilities. As for the proverbial elephants in the room? Let's just say they went unnoticed.

Critics might charge that nothing of substance was really accomplished. But at the very least, the hearing offered a template for other Republican-controlled health committees to emulate.

Politics has been called the art of compromise. But these days, it's increasingly looking more like the art of doing whatever it takes to stay in office.

John O'Connor is editorial director of McKnight's Senior Living. Email him at john.oconnor@mcknights.com.

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