Zirpoli: Senate health care bill hurts programs for 'old people'

Now that I'm old enough to start thinking about retirement and health insurance programs such as Social Security, Medicare and Medicaid, these abstract programs for "old people" suddenly have my interest.

Part of the Social Security program, Medicare is a federal health insurance program for people ages 65 or older, and people under 65 with certain disabilities. It was established in 1965, back in the day when the federal government actually tried to help millions of Americans secure health insurance. Imagine that.


Funding for Medicare comes from those Medicare payroll deductions most of us see in our paychecks. Medicare has different parts. Part A is what everyone 65 and older signs up for. It provides coverage for hospitalization, skilled nursing, home hospice and home health care. Part B covers basic medical services like going to the doctor's office, outpatient care and for durable medical equipment. If you are still employed and have insurance through your employer or your spouse's employer, you don't need Part B (yet). If you are not covered by your employer or spouse's employer, you will need to sign up for Part B and, perhaps, supplemental coverage of your choice. Part D is your Medicare prescription drug coverage.

Medicaid was also established in 1965. It is different from Medicare in terms of eligibility and coverage. As far as eligibility, Medicaid provides assistance to people based upon their income or lack thereof. In regards to coverage, Medicaid is America's largest health care insurer. It covers 1 out of 5 Americans, 2 in 5 children, 2 in 5 people with disabilities, and 3 in 5 people in nursing homes. It covers half of all long-term care expenses.

The Medicaid program is funded by both federal and state funds, with most states paying about 50 percent of the costs. It is specifically designed for people with limited income and, for millions of Americans, it is the insurance of last resort. Because the Medicaid program is an agreement between each state and the federal government, there are really about 50 different Medicaid programs. Medicaid in some states cover a long list of medical services such as, for example, eyeglasses, physical therapy, dental services and prosthetics. Some states offer very limited services. Co-pays also vary greatly by state.

Medicaid is already largely governed by each state and varies greatly from state to state. Be wary of politicians who want to give Medicaid "back to the states." What they really mean and want to do is pass more of the costs to the states. In addition, they want to give states greater flexibility in limiting coverage so that Congress can "cap" (read "cut") their contribution to the states. According to the Congressional Budget Office, the Senate health care plan would decrease Medicaid funding to the states by 26 percent in 10 years, and by 35 percent in 20 years. Most states would not be able — and some would not be willing — to make up the federal funding cuts. The CBO predicts that states would be forced to "eliminate optional services, restrict eligibility for enrollment or adopt some combination of those approaches."

For millions of Americans with disabilities, Medicaid cuts could mean the elimination of home-care support services, pushing them back into nursing homes and other institutional settings. At the same time, nursing homes are particularly vulnerable to the proposed Medicaid cuts included in both the House and Senate plans. Many rural hospitals would also be particularly harmed by decreases in Medicaid funding and some wonder how they will keep their doors open.

Medicaid funding allows millions of people with disabilities to live and work within the community as independently as possible with supports as necessary. Their lives literally depend upon these supports.

Under Obamacare, individuals making over $200,000 and couples making over $250,000 are taxed 3.8 percent on investment income to help pay for health care coverage for the poor. The House and Senate health care proposals eliminate this and other taxes which is why both bills require severe cuts to health care coverage for the poor, the elderly and the disabled. This is why so many people say that this political battle is more about tax cuts for the rich than it is about health care for all Americans.

House Speaker Paul Ryan stated in March to National Review editor Rich Lowry, "We've been dreaming of this [limiting Medicaid] since I've been around — since you and I were drinking at a keg." But for the millions of Americans who depending on Medicaid for their health care coverage or long-term care, their dreams are turning into nightmares.

Tom Zirpoli writes from Westminster. He is program coordinator of the human services management graduate program at McDaniel College. His column appears Wednesdays. Email him at