Recently, ads reporting Medicare cuts have spread across the nation provoking fear in the hearts of seniors and low-income Medicare Beneficiaries. The Nursing Home Industry, not consumer research and advocacy groups inform many of the ads. The ads mislead seniors about the impact of the Children’s Health and Medicare Protection Act (CHAMP). Two of the major issues in the debate center on Medicare Advantage and a one-year freeze on automatic payment increases to nursing homes.

The fact is, CHAMP strengthens traditional Medicare, which jointly with Medicaid covers more low-income & minority beneficiaries. Medicare has increased payment to facilities every year, yet Federal data show that Medicare facilities have fewer registered nurses every year. Medicare facilities have decreased RN staff despite regular increases in funding and despite the correlation between the amount of nursing care a resident receives and the quality of care in a nursing home. The underlying element in this debate is about how pumping more money into the nursing home industry does not ensure quality of care.

Medicare is estimated to become insolvent in 2019 but precious funds have overpaid Medicare Advantage, a private health insurance. Traditional Medicare is a “lifeline” for people who need the level of care nursing homes provide and are least able to pay for it. In fact, to avoid higher out-of-pocket costs, Medicare Advantage enrollees are commonly advised to convert to traditional Medicare during long nursing home stays. The Children’s Health and Medicare Protection Act will address the overpayments to Medicare Advantage and ensure access to health insurance for an estimated 5 million uninsured children through reauthorization of the State Children’s Health Insurance Plan (S-CHIP). Twenty-five percent of the nurse aides who actually take care of nursing home residents do not have health insurance for themselves and many more do not have coverage for their children – the very kinds of kids who would get health insurance through S-CHIP. Facts that consumers and policy makers should consider when deciding how to respond to the nursing home industry ads include:

1) Legislation exists to ensure traditional Medicare is available even if the overpaid and proportionately under enrolled Medicare Advantage plan is no longer offered. In addition, provisions in CHAMP expand coverage and access for Medicare beneficiaries.

2) CHAMP provides comprehensive health insurance for older adults and children. By supporting CHAMP & S-CHIP, our legislators address the health care policy needs of both generations.

The Nursing home level of care is a vital segment of our health care system. No one would argue against adequately funding nursing homes that do provide quality of life and quality care. If the automatic funding increases have not corresponded with increases in quality of care, perhaps we should re-evaluate the way nursing home care is funded. History has proven more money does not equal better care. Until 1997, nursing homes could set their own prices for therapy and ancillary services, and Medicare paid that price. Even in the “gravy” days, nursing homes were plagued with issues of resident safety, deficits in quality of care, and challenges with clinical outcomes.

Nursing home and long-term care reimbursement that rewards performance and outcomes would be more effective. It is time to send a message to long-term care providers that we support health care for seniors and Quality Care is the standard. I encourage the members of Congress to ensure access to health care and quality services by supporting CHAMP and reauthorizing S-CHIP. After all, our elders and our children are equally deserving of it.

Pamela Pope is President & CEO of Pope Institute for Health and Education. Pope Institute provides Elder Care Consumer Education & Elder Care Planning. Contact Pamela Pope at (314) 830-9000 with questions or email ppope@PopeInstitute.com. Visit Pope Institute online at www.PopeInstitute.com.

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